Maintaining patency of tunneled hemodialysis catheters--efficacy of aspirin compared to warfarin.
Maintaining patency of tunneled hemodialysis catheters--efficacy of aspirin compared to warfarin.
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保持隧道式血液透析导管的通畅——阿司匹林与华法林的疗效比较。
DOI：
10.1080/00365590310008938
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Lebon,LindaF
中科院分区：
文献类型：
--
作者：
Obialo,ChamberlainI;Conner,AnitaC;Lebon,LindaF
目的管道式血液透析导管(Caths)常因管腔梗阻血栓或管端形成纤维蛋白鞘而失效。坊间和非随机研究表明，阿司匹林(A)和/或华法林(W)可以延长导管通畅率。我们研究了长期使用A或W对原发导管通畅性的影响。材料和方法对3年的导管通畅性进行了前瞻性横断面监测。根据患者长期服用A(每天325r mg)或W作为对照(C)，将患者分组。研究的终点发生在患者动静脉瘘插管时，出现导管相关性菌血症或无法维持250rml/min的血流。结果63名患者完成了研究，平均年龄57r-r15岁。A组21例，W组11例，C组31例。A组、W组和C组120d的CASS存活率分别为91%、73%和29%(A与C，p r<；r 0.0001；W vs C，p r<；r 0.0001；A与W，p r=r ns)。A组、W组和C组的平均通畅时间分别为114r-r18、111r-r17和68r-r37天(A vs C，p r<；r 0.0001；W vs C，p r<；r 0.0001；A vs W，p r=r ns)。A组、W组和C组胃肠道出血并发症发生率分别为24%、18%和0%(A与C，p=0.02；W与C，p=0.02；A与W，p r=r ns)。与阿司匹林相关的胃肠道出血的相对危险度为0.71[95%可信区间(CI)0.11~4.4，p r=r0.7]，而在使用阿司匹林的老年患者中为1.14(CI 1.0~1.3，p r=r 0.008)。结论阿司匹林和华法林在延长导管通畅方面同样有效，但由于其增加了消化道出血的风险，因此不能明确建议将其作为治疗失败的常规用药。需要进一步的前瞻性和随机性研究。
ObjectiveTunneled hemodialysis catheters (caths) often fail as a result of luminal obstructive thrombus or formation of a fibrin sheath at the tip. Anecdotal and non-randomized studies have indicated that aspirin (A) and/or warfarin (W) can prolong cath patency. We examined the effect of chronic usage of either A or W on primary cath patency.Material and MethodsA prospective cross-sectional monitoring of cath patency was conducted over a 3-year period. Patients were grouped according to their long-term usage of either A (325 r mg daily) or W. Patients on neither medication served as a control (C). The end point of the study occurred at cannulation of the patients' arteriovenous fistulae, when there was development of cath-related bacteremia or when there was inability to maintain a blood flow of 250 r ml/min.ResultsSixty-three patients with a mean age of 57 r - r 15 years completed the study. There were 21 patients in the A group, 11 in the W group and 31 in the C group. Cath survival was 91%, 73% and 29% at 120 days for the A, W and C groups, respectively (A vs C, p r < r 0.0001; W vs C, p r < r 0.0001; A vs W, p r = r NS). The mean durations of cath patency were 114 r - r 18, 111 r - r 17 and 68 r - r 37 days for the A, W and C groups, respectively (A vs C, p r < r 0.0001; W vs C, p r < r 0.0001; A vs W, p r = r NS). Gastrointestinal (GI) bleeding complication rates were 24%, 18% and 0% for the A, W and C groups, respectively (A vs C, p r = r 0.02; W vs C, p r = r 0.02; A vs W, p r = r NS). The relative risk of GI bleeding associated with aspirin was 0.71 [95% confidence interval (CI) 0.11-4.4, p r = r 0.7] but among elderly aspirin users it was 1.14 (CI 1.0-1.3, p r = r 0.008).ConclusionBoth aspirin and warfarin are equally effective at prolonging cath patency but their routine use for failing caths cannot be unequivocally recommended because of the increased risk of GI bleeding. Further prospective and randomized studies are called for.
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DOI：
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