A survey of the clinical management of pediatric patients with asymptomatic central venous catheter-associated venous thromboembolism in Saudi Arabia

BACKGROUND: Central venous catheters (CVCs) are the main cause of venous thromboembolism (VTE) in critically ill children. The optimal first-line treatment for children with asymptomatic CVC-related VTE is unknown. Due to a paucity of clinical trials, clinical practice guidelines can offer only weak recommendations for the management of asymptomatic CVC-related VTE. METHODS: This case-based survey was designed to assess the current trends in local management strategies for pediatric patients with an asymptomatic CVC-related thrombosis. The survey focused on the use of the thrombophilia testing, management approach, duration of anticoagulation, and the use of secondary prophylaxis. We hypothesize that there will be significant variation in these four management areas, in the large part due to the aforementioned paucity of available data.REDCap® questions were sent to the members of the Saudi Arabian Pediatric Hematology/Oncology Society clinical forum/email database. We used a hypothetical case scenario to assess management strategies for asymptomatic CVC-related VTE and secondary prophylaxis. RESULTS: Seventy-one (30%) physicians responded to the survey. The majority of the respondents (83.3%) did not use thrombophilia testing. The far majority (95%) treated with anticoagulation. In contrast, the survey respondents varied widely in the duration of anticoagulation and the use of secondary prophylaxis. CONCLUSIONS: Asymptomatic CVC-related VTE is a common clinical entity with limited data guiding management. In Saudi Arabia, there remains considerable variability in the clinical management. These findings will help identify crucial knowledge gaps in the management of asymptomatic CVC-related VTE and facilitate clinical trials that will help establish evidence-based treatment guidelines.