导管相关血栓的治疗:系统审查,元分析和国家调查调查
Laurens A Oomen1, Janette van Diest1, Felice R M Lucas1
1Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Journal of vascular surgery. Venous and lymphatic disorders
|November 30, 2025
概括
用直接口服抗凝剂 (DOAC) 或低分子量肝素/维生素K对抗剂 (LMWH/VKAs) 治疗导管相关血栓形成 (CRT) 的复发率类似,但在癌症患者中更高. 证据受到观察偏差的限制,需要随机对照试验.
科学领域:
- 医学研究 医学研究
- 临床实践中的临床实践
- 血栓形成的管理
背景情况:
- 导管相关血栓塞 (CRT) 是中央静脉导管的一种并发症.
- 对CRT的最佳治疗策略仍然不确定.
- 这项研究系统地审查了CRT管理,并调查了当前的做法.
研究的目的:
- 评估当前的CRT管理策略.
- 为了比较不同抗凝固疗法对CRT的疗效和安全性.
- 识别证据上的差距,并指导未来的研究.
主要方法:
- 按照PRISMA指南对34项观察性研究进行系统审查.
- 基于抗凝剂类型的元分析和子组分析.
- 在荷兰的重症监护和血液学医生中对CRT治疗实践进行了全国性调查.
主要成果:
- 静脉血栓栓塞的复发率在癌症患者 (14.1) 和非癌症患者 (2.0) 中较高.
- 在DOAC (11.0) 和LMWH/VKA (7.6) 之间,复发率是可比的.
- 在DOAC (10.5%) 和LMWH/VKA (13.1%) 中,主要出血率相似.
- 低分子量肝素 (LMWH) 首选用于有症状的CRT,治疗持续时间可变.
结论:
- DOAC和LMWH/VKA显示CRT的静脉瘤复发率很低,但癌症患者的复发率更高.
- 实质性和可比性出血发生在两类抗凝剂中.
- 证据质量受到观察偏差的限制; LMWH在实践中普遍存在,持续时间不一致.
- 精心设计的随机对照试验对于建立最佳CRT治疗至关重要.
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