Comparison of perioperative practices for placement of central venous access devices (CVAD) in children with haemophilia-Reference-Cited by-同舟云学术

Comparison of perioperative practices for placement of central venous access devices (CVAD) in children with haemophilia

Published:2022-01-01 Issue:1 Volume:9 Page:96-102
ISSN:2055-3390
Container-title:The Journal of Haemophilia Practice
language:en
Short-container-title:

Author:

Kwan Celia¹^ORCID,Chan Anthony KC²^ORCID,Koh Pei Lin³^ORCID,Kadir Nur Insyirah Abdul⁴^ORCID,Decker Kay⁵^ORCID,Lim Chiew Ying⁴^ORCID,Lam Joyce Ching Mei⁴^ORCID

Affiliation:

1. Dept of Pediatrics , McMaster University , Hamilton , ON , Canada

2. Dept of Pediatrics , McMaster University , Hamilton , ON , Canada ; Hamilton Niagara Regional Hemophilia Program , McMaster Children's Hospital, Hamilton Health Sciences , Hamilton , ON , Canada ; Dept of Paediatrics and Adolescent Medicine , The University of Hong Kong , Hong Kong

3. Khoo Teck Puat-National University Children's Medical Institute , National University Health System , Singapore ; Dept of Paediatrics, Yong Loo Lin School of Medicine , National University of Singapore , Singapore

4. Children's Blood and Cancer Centre , KK Women's and Children's Hospital , Singapore

5. Hamilton Niagara Regional Hemophilia Program, McMaster Children's Hospital , Hamilton Health Sciences , Hamilton , ON , Canada

Abstract

Abstract Background In children with haemophilia (CwH), central venous access devices (CVADs) are frequently placed to aid in the delivery of factor concentrates. In those who develop inhibitors, CVADs also allow for easy venous access and facilitation of immune tolerance therapy. Aim In this study, we compare perioperative practices for CVAD placement in children with haemophilia to assess similarities and differences in practices across centres in two countries (Singapore and Canada). Methods Retrospective chart review was conducted involving CwH (with and without inhibitors) who underwent CVAD placement from January 2007 to September 2017 at two centres in Singapore and at one centre in Hamilton, Canada. Data obtained included demographics, operative details, preoperative investigations, perioperative factor replacement, use of bypassing agents, antibiotic and antifibrinolytic use, length of stay, complications and need for CVAD revision. Results Twenty-one CwH were included in the data analysis. Amongst those without inhibitors, the mean preoperative factor dose was 50.0 IU/kg (SD=7.6) in Singapore, and 72.4 IU/kg (SD=12.5) in Hamilton (p=0.002); mean total factor use in the perioperative period was 425.0IU/kg (SD=114.9) in Singapore and 646.8IU/kg (SD=118.1) in Hamilton (p=0.004); mean duration of clotting factor replacement was 5.3 days (SD=0.9) in Singapore and 6.9 days (SD=0.7) in Hamilton (p=0.004). Amongst those with inhibitors, the mean preoperative dose of rFVIIa was 160.5 mcg/kg (SD=99.9) in Singapore and 88.2 mcg/kg (SD=3.8) in Hamilton (p=0.244); mean total rFVIIa used from surgery to discharge was 3,008.0 mcg/kg (SD=2305.9) in Singapore and 2,640.2 mcg/kg (SD=134.1) in Hamilton (p=0.842); mean duration of rFVIIa cover was 5.3 days (SD=1.7) in Singapore and 9.5 days (SD=2.1) in Hamilton (p=0.054). None of the CwH without inhibitors developed postoperative complications, compared to 57% in those with inhibitors (p=0.006). Conclusion Amongst CwH without inhibitors, significant variations were seen in perioperative factor replacement. Amongst those with inhibitors, there were also differences in perioperative practices across centres, although not statistically significant. Across centres, CwH with inhibitors were found to have more postoperative complications.

Publisher

Walter de Gruyter GmbH

Link

https://www.sciendo.com/pdf/10.2478/jhp-2022-0013

Reference14 articles.

1. Coppola A, Di Capua M, Di Minno MN, et al. Treatment of hemophilia: a review of current advances and ongoing issues. J Blood Med 2010; 1: 183–95. doi: 10.2147/JBM.S6885.

2. Iorio A, Marchesini E, Marcucci M, Stobart K, Chan AK. Clotting factor concentrates given to prevent bleeding and bleeding-related complications in people with hemophilia A or B. Cochrane Database Syst Rev 2011; (9): Cd003429. doi: 10.1002/14651858.cd003429.pub4.

3. Manco-Johnson MJ, Abshire TC, Shapiro AD, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med 2007; 357(6): 535–44. doi: 10.1056/NEJMoa067659.

4. Langley AR, Stain AM, Chan A, et al. Experience with central venous access devices (CVADs) in the Canadian hemophilia primary prophylaxis study (CHPS). Haemophilia 2015; 21(4): 469–76. doi: 10.1111/hae.12713.

5. Rodriguez V, Mancuso ME, Warad D, et al. Central venous access device (CVAD) complications in Haemophilia with inhibitors undergoing immune tolerance induction: Lessons from the international immune tolerance study. Haemophilia 2015; 21(5): e369–e74. doi: 10.1111/hae.12740.