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Central venous access devices in haemophilia
L A Valentino1, B Ewenstein, R J Navickis
1RUSH Hemophilia and Thrombophilia Center, RUSH University and RUSH Children's Hospital, Chicago, IL 60612-3833, USA. lvalentino@rush.edu
Haemophilia : the Official Journal of the World Federation of Hemophilia
|February 14, 2004
Summary
Central venous access devices (CVADs) offer significant benefits for hemophilia patients needing long-term venous access. Serious complications are infrequent, with infection being the most common reason for CVAD removal.
Area of Science:
- Medical Devices
- Hematology
- Infectious Diseases
Background:
- Central venous access devices (CVADs) are crucial for administering coagulation factors in hemophilia patients.
- Indications for CVADs include immune tolerance therapy, difficult venous access, and prophylaxis.
- Both fully implanted and external CVADs are utilized, with a higher prevalence of fully implanted devices.
Purpose of the Study:
- To systematically review and meta-analyze complication rates associated with CVADs in hemophilia patients.
- To identify risk factors for poor outcomes, specifically infections and thrombosis.
- To evaluate the overall safety and efficacy of CVADs in this patient population.
Main Methods:
- Systematic review and meta-analysis of 48 studies involving 2704 patients and 2973 CVADs.
- Pooled incidence of infection and time to first infection were calculated.
- Risk factors for infection, including age and CVAD type, were analyzed using incidence rate ratios (IRRs).
Main Results:
- The pooled incidence of infection was 0.66 per 1000 CVAD days.
- Presence of inhibitors (IRR=1.67) was a risk factor for infection.
- Infection was less likely in patients over 6 years old (IRR=0.46) and with fully implanted CVADs (IRR=0.31).
- Infection was the primary reason for CVAD removal (69.9%).
Conclusions:
- CVADs provide substantial benefits for hemophilia patients requiring long-term venous access.
- Serious complications associated with CVADs in hemophilia patients are rare.
- Infection is the most common complication, but can be mitigated by patient age and CVAD type.