Results of a multinational survey on the diagnostic and management practices of catheter-related arterial thrombosis in children and neonates: communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis

Background: Arterial thrombosis is increasingly recognized in children and is most commonly related to the presence of an arterial catheter. Diagnosis and treatment of arterial thrombosis in children varies widely and consists of commonly available anticoagulants and antiplatelet drugs. No evidence-based guidelines exist for management strategies for catheter-related arterial thrombosis (CAT). Objectives: To understand pediatric hematologists' current practices and opinions in the management of CAT in children and neonates. Methods: A multinational survey on diagnostic and management practices from experts and practitioners in the field was conducted by means of a questionnaire with general questions and specific clinical CAT scenarios in regard to umbilical arterial catheters, extremity indwelling arterial catheters, and cardiac catheterization. Results: Of 54 complete survey responses, there was agreement that Doppler ultrasound is the preferred diagnostic modality to identify CAT and unfractionated heparin and low-molecular-weight heparin are the preferred antithrombotic treatments, while thrombolysis/thrombectomy is used in life-/limb-threatening CAT, long-term follow-up is necessary to detect adverse outcomes, and generally no thrombophilia testing is indicated. There was considerable heterogeneity in treatment indications on when to start antithrombotic treatment, treatment duration, timepoint of catheter removal, and length of follow-up. Conclusion: These results highlight some congruency, but also considerable heterogeneity, in the management practices of CAT. Based on these findings, an international guidance document is necessary to harmonize management practices and further clinical investigations of CAT.