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Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review
Clara P W Klerk1, Susanne M Smorenburg, Harry R Büller
1Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.p.klerk@amc.uva.nl
Insights
Thromboprophylaxis with warfarin and dalteparin significantly reduced catheter-related thrombosis in cancer patients. Heparin added to parenteral nutrition did not significantly reduce thrombosis risk, with no apparent increase in bleeding events.
Area of Science:
- Medical Research
- Clinical Practice
- Vascular Access
Background:
- Central venous catheters (CVCs) are widely used, but complications like thrombosis and infection are significant concerns.
- The benefit of thromboprophylaxis in CVC patients remains a subject of clinical debate.
- Understanding thromboprophylaxis efficacy is crucial for patient safety and optimal CVC management.
Purpose of the Study:
- To systematically review the literature on thromboprophylaxis for CVC-related thrombosis.
- To evaluate thromboprophylaxis in three distinct patient groups: parenteral nutrition, cancer, and intensive care unit patients.
- To provide accessible information for clinical practice regarding CVC thrombosis prevention.
Main Methods:
- Systematic review of existing studies.
- Analysis of data from three patient populations: parenteral nutrition, cancer, and intensive care unit patients.
- Evaluation of thromboprophylaxis efficacy and bleeding events associated with CVCs.
Main Results:
- Heparin added to parenteral nutrition showed a nonsignificant reduction in catheter-related thrombosis (RR 0.77, 95% CI 0.11-5.48).
- Low-dose warfarin and low-molecular-weight heparin significantly reduced thrombosis in cancer patients (RR 0.25, 95% CI 0.09-0.70 and RR 0.10, 95% CI 0.01-0.71, respectively).
- Limited data exist for intensive care unit patients; catheter type effect was not established due to small numbers. No significant increase in bleeding events was observed.
Conclusions:
- Heparin addition to parenteral nutrition did not significantly decrease CVC-related thrombosis risk.
- Warfarin and dalteparin demonstrated significant reduction in thrombosis risk for cancer patients with CVCs.
- Prophylactic anticoagulation in CVC patients did not appear to increase bleeding events.
Background:
Central venous catheters (CVCs) are used in a wide variety of patients. Associated complications are thrombosis and infection. It is a matter of debate whether thromboprophylaxis is beneficial.
Methods:
We performed a systematic review of 3 different patient populations to render the available information in the literature more accessible to clinical practice: patients receiving parenteral nutrition (PN), patients with cancer, and patients admitted to intensive care units.
Results:
Prophylaxis with heparin added to PN was found to give a nonsignificant reduction in the incidence of catheter-related thrombosis (pooled relative risk of randomized studies, 0.77; 95% confidence interval [CI], 0.11-5.48). In cancer patients, both low-dose warfarin and low-molecular-weight heparin significantly reduced the incidence of catheter-related thrombosis (relative risk of randomized studies, 0.25 [95% CI, 0.09-0.70] and 0.10 [95% CI, 0.01-0.71], respectively). So far, intensive care patients have hardly been studied with respect to thromboprophylaxis and the incidence of CVC thrombosis. Any effect of the type of catheter could not be established because of small numbers. There was no apparent increase in bleeding events with prophylactic anticoagulation in patients with CVCs.
Conclusions:
In the small number of patients studied, the addition of heparin to PN did not significantly decrease the risk of catheter-related thrombosis, whereas warfarin and dalteparin did decrease the thrombosis risk in cancer patients with CVCs. There is no apparent increase in bleeding events with prophylactic anticoagulants in patients with CVCs.