Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis
Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis
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DOI：
10.1093/annonc/mdl431
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发表时间：
2007-03-01
影响因子：
50.5
通讯作者：
Cimminiello, C.
中科院分区：
文献类型：
--
作者：
Fagnani, D.;Franchi, R.;Cimminiello, C.
背景：最近的指南不推荐使用抗血栓预防(AP)来预防中线癌症患者的导管相关血栓形成。患者和方法：本研究评估了癌症患者对中线的管理，目前对AP的态度，导管相关和全身静脉血栓，以及存活率。结果：在1410名纳入研究的患者中，1390人在6个月的中位随访期内至少见过一次。持续AP，主要是小剂量华法林，451例(32.4%)；他们年龄较大，有更频繁的静脉血栓栓塞症(VTE)病史和更晚期的癌症。有无AP患者导管相关血栓发生率差异无统计学意义(2.8%和2.2%，优势比1.29，95%可信区间0.64~2.6)。首次出现导管相关并发症的中位时间为120天。AP组全身静脉血栓，包括深、浅血栓和肺栓塞的发生率较低(4%比8.2%，P=0.005)。死亡率也较低(25%比44%，P=0.0001)。多因素Logistic回归分析发现，只有晚期癌症和AP与死亡率显著相关。结论：目前的AP治疗方案似乎不能预防导管相关的血栓形成。然而，全身性静脉血栓栓塞术和死亡率在预防后似乎较低。
Background: Recent guidelines do not recommend antithrombotic prophylaxis (AP) to prevent catheter-related thrombosis in cancer patients with a central line.Patients and methods: This study assessed the management of central lines in cancer patients, current attitude towards AP, catheter-related and systemic venous thromboses, and survival.Results: Of 1410 patients enrolled, 1390 were seen at least once in the 6-month median follow-up. Continuous AP, mainly low-dose warfarin, was given to 451 (32.4%); they were older, with a more frequent history of venous thromboembolism (VTE), and more advanced cancer. There was no difference in catheter-related thrombosis in patients given AP or not (2.8% and 2.2%, odds ratio 1.29, 95% confidence interval 0.64-2.6). The median time to first catheter-related complication was 120 days. Systemic VTE including deep and superficial thromboses and pulmonary embolism, were less frequent with AP (4% versus 8.2%, P = 0.005). Mortality was also lower (25% versus 44%, P = 0.0001). Multiple logistic regression analysis found only advanced cancer and no AP significantly associated with mortality. No major bleeding was recorded with AP.Conclusions: Current AP schedules do not appear to prevent catheter-related thrombosis. Systemic VTE and mortality, however, appeared lower after prophylaxis.