Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis

Abstract

CONTEXT: The risk of invasive device–related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES: This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES: Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION: Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION: Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES: Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS: Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3–5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00–0.07), whereas asymptomatic was 10% (95% CI, 7–13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14–0.36). Both ventricular assist devices (28%; 95% CI, 19–39) and extracorporeal membrane oxygenation (67%; 95% CI, 52–81) were often associated with major bleeding complications. CONCLUSIONS: This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.