Thromboprophylaxis of central venous lines in children with cancer: the first steps taken on the long road ahead.

UNLABELLED: Approximately one third of children with malignancy and central venous lines develop catheter-related thrombosis, with the reported sequelae including death, pulmonary embolism, chylothoraces, superior vena cava syndrome and post-thrombotic syndrome. These complications prompt the design and completion of randomized, controlled trials to determine a safe and efficacious therapy to prevent these thromboses. The authors Ruud et al. have presented a well-designed, randomized, controlled trial which demonstrates the lack of utility of using low-dose warfarin to prevent catheter-related thrombosis in children with central lines and acute lymphoblastic leukaemia. The difficulties with warfarin in children are again demonstrated in this study.

CONCLUSION: Further studies are warranted using other thromboprophylactic agents with less or no monitoring and fewer drug interactions, including the newer anticoagulant agents such as direct thrombin inhibitors.