Patients with postural orthostatic tachycardia syndrome (POTS) have high rates of thrombosis related to central venous catheter placement. Anticoagulant thromboprophylaxis (AT) reduced CVC-related thrombosis and did not increase bleeding, according to research presented at the 2021 American Society of Pediatric Hematology/Oncology (ASPHO) meeting.
Teens and young adults with medication-resistant POTS who require CVC for intravenous fluids may be at higher risk of developing venous thromboembolism (VTE). This study sought to determine whether AT could reduce the risk or incidence of VTE.
The study authors included 17 female adolescents with POTS who had multiple VTE risk factors. The median age of patients was 15.5 years. Patients were enrolled between 2012 and 2020 at Children’s National Hospital. The hospital instituted an AT protocol in 2017.
Before Children’s National implemented the AT protocol, 8 patients with POTS developed deep vein thrombosis (DVT), with 7 of those CVC-related and received anticoagulation therapy. After the protocol was initiated in 2017, 9 patients who needed a CVC received the prophylaxis, and only 1 patient developed VTE. The prevalence of VTE was 0.14 event per 1000 CVC days. No patients experienced major bleeding episodes.
The authors concluded that CVC-related thrombosis is a risk for patients with POTS. Thromboprophylaxis was feasible and reduced risk of VTE without evidence of major bleeding or clinically relevant non-major bleeding.
The authors suggested future studies examine larger patient populations and quality of life measures. Direct oral anticoagulation may also be an option for patients with POTS and should be explored in future studies.
Martin, OY, Darbari DS, Moak JP, et al. Venous thromboembolism risk and role of thromboprophylaxis in youth with POTS. Poster presented at: 2021 American Society of Pediatric Hematology/Oncology meeting; April 21-23, 2021; virtual.