Anticoagulants to prevent CVC thrombosis
Abstract:
Background: Catheter-related venous thrombosis (CRVT) is a severe complication of home parental nutrition (HPN). Although primary prevention of CRVT is crucial, there is no consensus on anticoagulant use to prevent this adversity. Aim of this study was to compare CRVT risk in chronic intestinal failure (CIF) patients in the presence or absence of anticoagulants, and to identify CRVT risk factors.
Methods: This retrospective cohort study comprised adult CIF patients with a central venous access device (CVAD) between 2010 and 2020 who were treated at our national CIF referral center. Analyses were performed at CVAD level. Primary outcome was the CRVT risk of CIF patients using anticoagulants compared to those without anticoagulants.
Results: Overall, 1188 CVADs in 389 patients were included (540.800 CVAD days). Anticoagulants were used in 403 CVADs. In total, 137 CRVTs occurred in 98 patients, resulting in 0.25 CRVTs/1000 CVAD days (95%CI 0.22-0.29). Anticoagulant use was associated with a decreased CRVT risk (OR 0.53 95%CI 0.31-0.89; P = 0.02). Left-sided CVAD insertion (OR 2.00 95%CI 1.36-2.94), a history of venous thrombosis (OR 1.73 95%CI 1.05-2.84), and a shorter period post-insertion (OR 0.78 95%CI 0.65-0.92) were independently associated with an increased CRVT risk.
Conclusion: Anticoagulants decreased the CRVT risk. In addition, we identified left-sided vein insertion, a history of venous thrombosis, and a shorter period post CVAD insertion as CRVT risk factors. Further prospective studies should provide guidance whether prophylactic anticoagulant use, especially in higher-risk patients with a left-sided CVAD or a history of venous thrombosis, is justified.
Reference:
Gillis VE, van Houdt T, Wouters Y, Wanten GJ. Anticoagulants decrease the risk for catheter-related venous thrombosis in patients with chronic intestinal failure: A long-term cohort study. JPEN J Parenter Enteral Nutr. 2021 Dec 29. doi: 10.1002/jpen.2323. Epub ahead of print. PMID: 34967025.