Central venous access devices in haemophilia


Leonard A. Valentino, MD, Associate Professor of Pediatrics, Director, RUSH Hemophilia and Thrombophilia Center, RUSH University and RUSH Children's Hospital, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA.
Tel.: +1-312-942-8114; fax: +1-312-563-2317;
e-mail: lvalentino@rush.edu


Summary.  Central venous access devices (CVADs) can facilitate repeated and/or urgent administration of coagulation factors in haemophilic patients. We conducted a systematic review and meta-analysis of complication rates and risk factors for poor outcome. Forty-eight studies with a total of 2704 patients and 2973 CVADs were included. The primary indications for CVADs were immune tolerance therapy (34.9% of patients), difficult venous access (31.8%) and prophylaxis (29.1%). Fully implanted CVADs were employed in 77.4% of cases and external CVADs in 22.6%. A total of 1190 infections were reported, and the pooled incidence of infection was 0.66 per 1000 CVAD days [confidence interval (CI), 0.44–0.97 per 1000 CVAD days]. Among patients developing infection, the pooled time to first infection was 295 days (CI, 181–479 days). Presence of inhibitors was an independent risk factor for infection with an incidence rate ratio (IRR) of 1.67 (CI, 1.15–2.43). Infection was less likely in patients >6 years of age (IRR, 0.46; CI, 0.27–0.79) and recipients of fully implanted CVADs (IRR, 0.31; CI, 0.12–0.86). Available information on thrombosis was limited, with only 55 cases being reported. Eventually, 31.3% of CVADs were removed, and infection was the reason for removal in 69.9% of cases and thrombosis in 4.1%. The pooled time period CVADs remained indwelling prior to removal or the expiration of the study observation period was 578 days per CVAD (CI, 456–733 days per CVAD). CVADs can confer major benefits in patients with haemophilia requiring long-term venous access, and serious complications are rare.