低分子肝素钙在妇科肿瘤腹腔镜术后深静脉血栓预防中的效果观察

目的探讨低分子肝素钙在妇科肿瘤腹腔镜术后深静脉血栓(DVT)预防中的应用效果。方法选取2017年1月至2018年9月间上海市长征医院收治的138例行腹腔镜手术治疗的妇科肿瘤患者,采用随机数字表法分为A组和B组,每组69例。A组患者术前0. 5h单次皮下注射低分子肝素钙5000U,B组患者术后12h皮下注射低分子肝素钙5000U,连用5d。比较两组患者术前和术后5d血小板(PLT)、血红蛋白(Hb)、纤维蛋白原(FIB)和D-二聚体(D-D)水平,统计两组患者手术指标、术后DVT发生率和出血性事件发生情况。结果 A组患者围手术期DVT发生率为2. 9%(2例),B组患者为4. 3%(3例),两组比较,差异无统计学意义(P> 0. 05)。两组患者气腹压力、术中出血量、麻醉时间和手术时间比较,差异均无统计学意义(均P> 0. 05)。术前和术后5d,两组患者FIB、D-D、PLT和Hb水平比较,差异均无统计学意义(均P> 0. 05)。治疗过程中,两组患者均未出现皮下出血和过敏等并发症。结论术前单次低分子肝素钙预防妇科肿瘤腹腔镜手术患者术后DVT发生的效果和安全性与术后应用低分子肝素钙类似,但单次应用减轻了患者的经济负担和注射痛苦,值得临床推广应用。     

食管癌术后应用低分子肝素钙预防深静脉血栓形成

目的:探讨低分子肝素钙预防食管癌术后深静脉血栓的临床价值。方法:选取食管癌患者180例,根据术后是否应用低分子肝素钙随机分为治疗组和对照组。分别在治疗前后比较两组患者组织型血浆酶原激活剂(t-PA)、血浆酶原激活物抑制剂(PAI)、纤维蛋白原(FIB)及D-二聚体(D-D)的差异,观察有无发生深静脉血栓(DVT)及术后出血等不良反应,并对DVT患者进行危险因素分析。结果:对照组、治疗组术后PAI、FIB以及D-D水平均较术前低,t-PA水平较术前高;治疗组术后PAI、FIB以及D-D水平均较对照组术后低,t-PA水平较对照组高,以上差异均有统计学意义(分别P＜0.05及P＜0.01)。治疗组DVT、肺栓塞、心肌梗死发生率低于对照组,差异有统计学意义(P＜0.05);心源性猝死和术后出血发生率两组差异无统计学意义(P＞0.05)。既往冠心病、下肢静脉曲张、肥胖以及年龄>65岁是导致食管癌术后易患DVT的独立危险因素(P＜0.05)。结论:早期应用低分子肝素钙对于预防食管癌术后伴发DVT安全且疗效肯定。     

胰腺癌术后应用低分子肝素钙预防深静脉血栓的临床价值

目的:探讨低分子肝素钙预防胰腺癌术后深静脉血栓的临床价值.方法:选取胰腺癌患者180例,根据术后是否应用低分子肝素钙随机分为治疗组和对照组.分别在治疗前后比较两组患者组织型血浆酶原激活剂(t-PA)、血浆酶原激活抑制剂(PAI)、纤维蛋白原(FIB)及D-二聚体(D-D)的差异,观察有无发生深静脉血栓(DVT)及术后出血等不良反应,并对DVT患者进行危险因素分析.结果:对照组、治疗组术后PAI、FIB以及D-D水平均较术前低,t-PA水平较术前高;治疗组术后PAI、FIB以及D-D水平均较对照组术后低,t-PA水平较对照组高,差异均有统计学意义(分别P<0.05及P<0.01).治疗组DVT、肺栓塞、心肌梗死发生率低于对照组,差异有统计学意义(P<0.05);心源性猝死和术后出血发生率两组差异无统计学意义(P>0.05).多因素分析结果显示,肥胖、既往冠心病、下肢静脉曲张是导致胰腺癌术后易患DVT的独立危险因素(P<0.05).结论:早期应用低分子肝素钙对于预防胰腺癌术后伴发DVT安全且疗效肯定.     

巴曲亭在NSCLC手术低分子肝素抗凝中的应用研究

目的 探讨肺癌患者术中配合低分子肝素抗凝时加用巴曲亭对预防下肢静脉血栓形成的临床疗效.方法 选取137例行肺叶或全肺切除术治疗的非小细胞肺癌患者,随机分为观察组和对照组.观察组术中注射巴曲亭,对照组给予相同剂量的安慰剂,两组患者均在术后12小时内开始预防性使用低分子肝素.观察比较两组患者术中出血量、术后总引流量、血液凝固水平及下肢静脉血流情况.结果 观察组患者的术中出血量、术后总引流量分别为(354.32±75.20) mL、(211.52±72.16) mL,与对照组比较差异有统计学意义(P＜0.05).手术前后血液凝固水平两组差异不明显(P＞0.05).术后5天下肢深静脉彩色多普勒超声检查示,观察组2例发生下肢深静脉血栓,对照组1例,其余患者的下肢深静脉回流速度和回流血量差异不明显(P＞0.05).结论 术中应用巴曲亭能够明显减少应用低分子肝素抗凝的肺癌术后患者的出血量,且不会增加下肢静脉血栓的发生率,具有一定的临床推广价值.     

药物预防妇科盆腔术后下肢深静脉血栓形成的Meta分析

目的：探讨不同药物预防妇科盆腔术后下肢深静脉血栓形成的效果。方法检索国内外已发表的相关文献,选择比较药物预防妇科盆腔术后下肢深静脉血栓形成的所有随机对照试验,提取资料后对疗效、副反应进行Meta分析,计算不同药物对妇科盆腔术后下肢深静脉血栓形成的的影响。结果从1988年－2014年,组①观察组为单一药物,对照组为不采用预防性用药预防妇科盆腔术后下肢深静脉血栓形成,有5项研究入选,共969例患者,观察组509例,对照组460例,分析结果显示药物可有效预防妇科盆腔术后下肢深静脉血栓形成（ OR＝0．2,95％CI为0．09～0．44, P＜0．0001）;术后引流物量比较无统计学意义（MD 7．61,95％CI为－11．71～26．93,P＝0．44）。组②去纤肽与肝素钙对比研究的3篇,纳入患者313例。预防下肢深静脉血栓形成差异无统计学意义（ OR＝0．19,95％CI为0．01～4．11,P＝0．29）。结论预防性使用低分子肝素、丹参、去纤肽等可降低妇科盆腔手术术后下肢深静脉血栓的形成的风险,未增加术后引流物量及出血。去纤苷与低分子肝素钙效果相当。     

超声监测胸外科肿瘤术后低分子肝素预防深静脉血栓的临床研究

目的探讨应用超声监测胸外科肿瘤术后给予低分子肝素预防深静脉血栓的临床效果。方法将2010年1月至2010年12月间80例行胸外科恶性肿瘤手术治疗的患者随机分为两组,每组各40例。观察组患者术后给予低分子肝素治疗,对照组患者术后未给予低分子肝素治疗,对两组患者进行超声检查,观察深静脉血栓发生的情况。结果两组患者手术时间、胸腔引流量、拔管时间比较差异无统计学意义（P〉0．05）;观察组患者静脉血栓形成率显著低于对照组,差异有统计学意义（P〈0．05）;两组患者D-二聚体、血小板计数（PLIT）和纤维蛋白原（FIB）治疗后均有不同程度的改善,差异有统计学意义（P〈0．05）。治疗1d后两组患者的观察指标比较无显著性差异（P〉0．05）,但治疗3天后,FIB和D-二聚体比较,差异有统计学意义（P〈0．05）。结论临床上胸外科肿瘤手术后给予低分子肝素能够有效预防深静脉血栓的形成,超声能够作为早期监测患者下肢深静脉血栓形成的重要方法。     

低分子量肝素钙预防直肠癌术后下肢深静脉血栓的效果观察

目的探讨低分子量肝素钙预防直肠癌术后下肢深静脉血栓的效果。方法回顾性病例对照研究。回顾性分析2018年2月至2022年2月北京市和平里医院30例直肠癌术后皮下注射低分子量肝素钙患者的临床资料, 选择同期穿抗血栓弹力袜患者30例为对照。抗血栓弹力袜组术后依据患者实际情况选择合适的抗血栓弹力袜。低分子量肝素钙组术后第2天给予患者皮下注射低分子量肝素钙。分析两组患者凝血功能指标、术后下肢深静脉血栓形成情况、围术期指标。结果低分子量肝素钙组女性17例, 男性13例, 年龄(62±12)岁;抗血栓弹力袜组女性18例, 男性12例, 年龄(63±1)岁。预防前两组患者的血小板计数(Plt)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)及D-二聚体(D-D)水平之间的差异均无统计学意义(均P>0.05);预防后低分子量肝素钙组患者的FIB、D-D水平[(3.3±0.7)g/L、(341±30)μg/L]均低于抗血栓弹力袜组[(4.9±0.6)g/L、(428±40)μg/L](t值分别为9.51、9.61, 均P<0.05), 但两组患...     

低分子肝素预防肿瘤患者经外周静脉穿刺中心静脉置管术后深静脉血栓的效果

目的探讨低分子肝素(LMWH)预防经外周静脉穿刺中心静脉导管(PICC)术后深静脉血栓(DVT)发生的效果。方法回顾性分析2012年1月至2014年12月间收治的742例PICC置管术后患者DVT的发生情况,并对2012年1月至2014年12月间PICC置管术后发生DVT的患者应用LMWH后再发深静脉血栓情况进行统计,与同期PICC置管术后未应用过LMWH的患者进行比较。结果 PICC置管术后DVT发生率为7.1%,其发生与D-二聚体增高、感染、伴糖尿病或高血压、冠心病等慢性疾病、长期卧床等因素相关。PICC置管术后发生DVT的患者应用LMWH后再发深静脉血栓发生率为零,PICC置管术后未应用过LMWH的患者DVT发生率为7.1%,两者比较差异均有统计学意义(P<0.05)。结论肿瘤患者PICC置管后DVT发生率较高,其发生率与与D-二聚体增高、感染、伴糖尿病或高血压、冠心病等慢性疾病、长期卧床等因素相关;LMWH可显著降低DVT发生率,且具有良好的安全性,值得在有DVT高发风险的PICC患者中进行预防性应用。     

丹参注射液预防胸科手术后患者下肢深静脉血栓形成的临床研究

目的:探讨丹参注射液用于预防胸科手术后患者下肢深静脉血栓形成(Deep vein thrombosis,DVT)的效果。方法:将100例胸科食管癌、贲门癌手术患者随机分为用药组(50例)和未用药组(50例),前瞻性比较术前及术后1周患者血液黏度、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(Fbg);行双下肢静脉超声检查;并记录有无异常出血、胸腔引流液量有无增加等临床症状。结果:血流变及凝血功能比较:两组患者手术前各项指标比较,无显著性差异(P>0.05);用药组手术后各项指标较手术前有下降趋势,但无显著性差异(P>0.05)。经双下肢静脉超声检查发现,用药组DVT发生率为12%,未用药组DVT发生率为26%,两者比较,有显著性差异(P<0.05);治疗期内,两组均未出现异常出血,胸腔引流量稍增多,但无显著性差异(P>0.05)。结论:丹参注射液能明显改善胸科手术后患者血液流变学的各项指标,降低DVT发生率,用于预防胸科手术后患者DVT可取得较好的疗效,值得进一步推广。     

3D和2D腹腔镜在直肠癌根治手术中的临床疗效比较

目的探究3D和2D腹腔镜在直肠癌根治术的临床价值对比。方法选取2016年5月至2018年5月我院就诊的114例直肠癌患者,采用随机数字表分组,分观察组和对照组,各57例,两组患者入组后完善术前准备,均行腹腔镜下直肠癌根治术,其中观察组患者采用3D腹腔镜下直肠癌根治术治疗,对照组患者采用2D腹腔镜下直肠癌根治术治疗,比较两组患者手术情况,包括手术时间、术中出血量、淋巴结清扫数目等;比较两组患者术后恢复情况及并发症发生情况;比较两组患者术后标本病理学指标;比较两组患者术后引流管留置时间。结论观察组患者手术时间、术中出血量较对照组患者明显降低,结果具有统计学意义(P<0.05),两组患者淋巴结清扫数目无明显差异;观察组患者术后并发症发生率较对照组患者明显降低,结果具有统计学意义(P<0.05),两组患者胃肠功能恢复时间、住院时间、住院费用等差异无统计学意义(P>0.05);两组患者术后病理指标,包括肿瘤距切缘下距离与标本长度无明显差异(P>0.05);观察组患者引流管留置时间较对照组患者明显降低,差异具有统计学意义(P<0.05)。结论3D腹腔镜下直肠癌根治术较传统2D腹腔镜下直肠癌根治术临床效果更好,并发症发生率更低,能有效缩短住院时间,对患者术后快速康复有一定积极。     

Does prolonged thromboprophylaxis improve outcome in patients undergoing surgery?

Patients undergoing major abdominal surgery, particularly for malignancy, are at increased risk of venous thromboembolism. Haemostatic markers of coagulation are raised for several weeks after surgery. A higher dose of low-molecular-weight heparin than normally used for thromboprophylaxis is effective in preventing post-surgical VTE in patients with cancer with no compromise on bleeding. Four weeks' of thromboprophylaxis with the LMWH dalteparin is significantly more effective than standard (1 week) thromboprophylaxis in preventing proximal DVT. A meta-analysis of studies comparing 4 weeks' with 1 week of thromboprophylaxis showed that prolonged thromboprophylaxis with LMWH following major abdominal surgery for malignancy significantly reduces the risk of late occurring DVT.     

Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours

BackgroundPatients with germ cell tumours (GCT) receiving cisplatin-based chemotherapy are at high risk of thromboembolic events (TEE). Previously, we identified serum lactate dehydrogenase (LDH) and body surface area (BSA) as independent predictive factors for TEE.The aim of this study was to validate these predictive factors and to assess the impact of thromboembolism prophylaxis in patients at risk of deep venous thrombosis (DVT).MethodsBetween 2001 and 2014, 295 patients received first-line cisplatin-based chemotherapy for GCT. Preventive anticoagulation with low-molecular-weight heparin (LMWH) was progressively implemented in patients with predictive factors. Sixteen patients with evidence of TEE before starting chemotherapy were excluded from the analysis.ResultsAmong 279 eligible patients, a TEE occurred in 38 (14%) consisting of DVT (n = 26), arterial thrombosis (n = 2), and superficial thrombophlebitis (n = 10). DVT occurred in 26 (12.7%) of 204 patients with risk factors versus two (2.6%) of 75 patients with no risk factors (p = 0.01).After a prevention protocol was progressively implemented from 2005, primary thromboprophylaxis was administered to 104 patients (68%) with risk factors. Among patients at risk (n = 151), the incidence of DVT decreased by roughly half when they received a LMWH: 9/97 (9.2%) and 9/54 (16.6%), respectively (p = 0.23).ConclusionPatients with GCT who receive cisplatin-based chemotherapy are at risk of developing a TEE which can be predicted by elevated serum LDH. To our knowledge this is the first study exploring LMWH as thromboprophylaxis in GCT patients. A prospective trial testing prophylactic anticoagulation is warranted.     

低分子量肝素预防胸部肿瘤开胸术后血栓性疾病的临床研究

目的观察低分子量肝素预防胸部肿瘤开胸术后血栓性疾病的效果。方法将2004年1月至2005年8月住我科的食管癌、贲门癌、肺癌患者随机分为治疗组和对照组,每组320例,治疗组于术后第1天开始皮下注射低分子量肝素,每日1次,连用5d,观察术后胸液量并统计血栓性疾病发生率。结果两组患者胸液量差异无显著性(P>0.05),治疗组血栓性疾病发生率明显低于对照组(P<0.01)。结论低分子量肝素预防胸部肿瘤开胸术后血栓性疾病有明显效果,较为安全可靠。     

Effect of low molecular weight heparin (Certoparin) versus unfractionated heparin on cancer survival following breast and pelvic cancer surgery: A prospective randomized double-blind trial

Recent studies suggest that low molecular weight heparin (LMW heparin) therapy in malignancy may improve cancer survival following surgical resection. We studied prospectively whether cancer mortality during follow-up in women with previously untreated breast, and pelvic cancer is reduced in those who randomly received LMW heparin (Certoparin) compared to patients given unfractionated heparin (UF heparin) for thrombosis prophylaxis during primary surgery. In a prospective, randomized, double-blind clinical trial, 160 patients received Certoparin and 164 UF heparin until post-operatively day 7. Survival estimations are based on the outcome data from a subset of 140 LMW heparin - and 147 UF heparin recipients. Long-term survival in the Certoparin group compared to the UF heparin group was significantly improved after 650 days (P=0. 0066) but not thereafter when analysis was performed on all cancer cell types combined. In the probability estimates survival benefit within this time was restricted to patients with pelvic cancer but was not observed in breast cancer. However, in breast cancer patients who received LMW heparin the impact of classical tumor prognostic markers was statistically significant after 1,050 days but not after 650 days. Thus, breast cancer patients with unfavorable prognosis seem to benefit in terms of survival advantage from LMW heparin within the 650 days after surgery. These results suggest that improvement in cancer survival can be achieved after even a short course of treatment with LMWH (compared to UFH) given for DVT prophylaxis in the post-operative period. An effect of UFH on disease outcome is not excluded. Further definitive trials of LMWH vs. placebo for cancer outcome (rather then DVT) using doses and schedules that may be more optimal are indicated.     

Low molecular weight heparin for venous thromboembolism prophylaxis in urologic oncologic surgery

OBJECTIVES: This is a prospective study in the use of low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis in the previously unstudied subset of patients undergoing elective urologic cancer surgery. METHODS: Thirty-eight patients undergoing elective urologic surgery were studied. Thirty-six had urologic malignancies. Pre-operative risk factors for venous thromboembolic disease were recorded. All patients received LMWH (dalteparin, Fragmin; Pharmacia, Stockholm, Sweden) subcutaneously on a daily basis beginning 1-2 hr before surgery and lasting for 3-7 days. Postoperative physical examination was used to check for clinical evidence of deep venous thrombosis (DVT). Clinical parameters such as physical examination and radiological testing were used to assess for evidence of DVT. Other data included intraoperative blood loss, transfusion requirements, postoperative bleeding complications, postoperative hematocrit and coagulation profiles, and local complications related to the subcutaneous injection of the LMWH. RESULTS: All patients completed the prophylaxis protocol. None developed DVT. Mean intraoperative blood loss was 735 mL and 12 patients received an average of 1 unit of blood transfusion. No unusual hemorrhagic events were noted intra- or post-operatively. No reactions to the LMWH were noted. Average hematocrit of postoperative day 3 was 30.7 and platelet count and coagulation profiles remained normal postoperatively. CONCLUSIONS: Low molecular weight heparins appear promising for DVT prophylaxis in high-risk urology patients.     

Prophylaxis of catheter-related deep vein thrombosis in cancer patients with low-dose warfarin, low molecular weight heparin, or control: a randomized, controlled, phase III study

Purpose

Whether an anticoagulant prophylaxis is needed for patients with cancer with a central venous catheter is a highly controversial subject. We designed a study to compare different prophylactic strategies over 3 months of treatment.

Methods

We performed a phase III prospective, open-label randomized trial. After the insertion of a central venous access device, consecutive patients with planned chemotherapy for cancer were randomized to no anticoagulant prophylaxis, low molecular weight heparin [low molecular weight heparin (LMWH); with isocoagulation doses], or warfarin 1 mg/day. Treatments were given over the first 3 months. Doppler ultrasound and venographies were performed on days 1 and 90, respectively, or sooner in case of clinical presumption of thrombosis.

Results

A total of 420 patients were randomized, and 407 were evaluable. Forty-two catheter-related deep vein thrombosis (DVT) occurred (10.3 %), 20 in those with no anticoagulation, 8 in those receiving warfarin, and 14 in those receiving LMWH. Nine additional non-related catheter deep vein thrombosis (CDVT) occurred. Anticoagulation significantly reduced the incidence of catheter-related DVT (p = 0.035) and catheter non-related DVT (p = 0.007), with no difference between warfarin and LMWH. Safety was good (3.4 % of attributable events) but compliance with randomized prophylaxis was lower than expected.

Conclusions

Prophylaxis showed a benefit regarding catheter-related and non-catheter-related DVT with no increase in serious side effects.     

Anti-thrombotics in thrombosis and cancer

Many cancer patients have a reportedly hypercoagulable state, with recurrent thrombosis due to the impact of cancer cells and chemotherapy or radiotherapy on the coagulation cascade. Studies have demonstrated that unfractionated heparin or its low-molecular-weight fractions interfere with various processes involved in tumor growth and metastasis. These include fibrin formation; binding of heparin to angiogenic growth factors, such as basic fibroblast growth factor and vascular endothelial growth factor; modulation of tissue factor; and perhaps other more important modulatory mechanisms, such as enhanced tissue factor pathway inhibitor (TFPI) release and inhibition of various matrix-degrading enzymes. Clinical trials have suggested a clinically relevant effect of low-molecular-weight heparin (LMWH), as compared with unfractionated heparin, on the survival of cancer patients with deep vein thrombosis. Similarly, the impact of warfarin on the survival of cancer patients with thromboembolic disorders was demonstrated. Studies from the author's laboratory demonstrated a significant role for LMWH, warfarin, anti-VIIa, and LMWH-releasable TFPI on the regulation of angiogenesis, tumor growth and tumor metastasis. Thus, modulation of tissue factor/VIIa noncoagulant activities by LMWH, warfarin, anti-VIIa, or TFPI may be a useful therapeutic method for the inhibition of angiogenesis associated with human tumor growth and metastasis. Additionally, antiplatelet drugs may have an impact on tumor metastasis, and the combination of antiplatelets and anticoagulants at adjusted doses may provide greater benefits to cancer patients.     

Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Urologic Oncologic Surgery

Objectives: This is a prospective study in the use of low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis in the previously unstudied subset of patients undergoing elective urologic cancer surgery.

Methods: Thirty-eight patients undergoing elective urologic surgery were studied. Thirty-six had urologic malignancies. Pre-operative risk factors for venous thromboembolic disease were recorded. All patients received LMWH (dalteparin, Fragmin; Pharmacia, Stockholm, Sweden) subcutaneously on a daily basis beginning 1-2 hr before surgery and lasting for 3-7 days. Postoperative physical examination was used to check for clinical evidence of deep venous thrombosis (DVT). Clinical parameters such as physical examination and radiological testing were used to assess for evidence of DVT. Other data included intraoperative blood loss, transfusion requirements, postoperative bleeding complications, postoperative hematocrit and coagulation profiles, and local complications related to the subcutaneous injection of the LMWH.

Results: All patients completed the prophylaxis protocol. None developed DVT. Mean intraoperative blood loss was 735 mL and 12 patients received an average of 1 unit of blood transfusion. No unusual hemorrhagic events were noted intra- or post-operatively. No reactions to the LMWH were noted. Average hematocrit of postoperative day 3 was 30.7 and platelet count and coagulation profiles remained normal postoperatively.

Conclusions: Low molecular weight heparins appear promising for DVT prophylaxis in high-risk urology patients.     

Low-molecular-weight heparin and calcium heparin in thrombosis prophylaxis in patients with percutaneous arterial and venous ports for colorectal liver metastases

STUDY OBJECTIVE: The evaluation of low-molecular-weight heparin use to prevent arterial and venous thrombosis in patients with indwelling arterial Port-a-Cath implants. METHODS: From 1996 to March 2003 we placed 370 indwelling hepatic arterial catheters with a minimally invasive approach. The left distal subclavian artery was approached from beneath the left clavicle, then an angiographic study of the tumoral vascular district was performed and the gastroduodenal artery was occluded by an embolus. A polyurethane catheter was introduced distally into the hepatic artery and connected to a reservoir through a 3-4 cm long subcutaneous tunnel. In 90 patients a venous Port-a-Cath was placed for concurrent systemic chemotherapy. All 370 patients received regional chemotherapy and were treated with calcium heparin at a dose of 5000 IU twice a day and with low-molecular-weight heparin at prophylactic doses (dalteparin 2500 IU or nadroparin 3000 IU) during catheter permanence to prevent hepatic artery thrombosis. Intra-arterial trans-port radionuclide scans using technetium-99m-labeled micro-aggregated albumin were performed monthly to check the infusion distribution and hepatic artery patency. In the presence of anomalous patterns, thrombosis, pulmonary embolism or other complications, angiography and/or other diagnostic studies were performed to determine the cause of the vascular event and the local or systemic symptoms. The mean arterial and venous Port-a-Cath permanence times were 6 and 8 months, respectively. RESULTS: We observed episodes of hepatic artery thrombosis in 4.3% of patients. Three of these 17 patients were successfully treated by intra-arterial thrombolysis using urokinase. No venous thrombosis occurred as a consequence of regional and/or systemic chemotherapy, no episodes of arterial thrombosis were registered during arterial catheter permanence, nor did any hemorrhagic complications related to anti-coagulant therapy occur. Five patients treated with low-molecular-weight heparin required treatment suspension due to a platelet count of < 40,000/dL. CONCLUSION: Our experience suggests that low-molecular-weight heparin and/or calcium heparin at prophylactic doses could be useful in the prevention of arterial and venous thrombosis in patients with indwelling arterial catheters or venous Port-a-Cath treated with regional or systemic chemotherapy for hepatic metastases from colorectal cancer. The homogeneity of the patient group and the use of analogous chemotherapeutic drugs (fluoropyrimidines) avoided statistical contamination related to differences between kinds of cancer and between the chemotherapeutic agents used.     

Catheter-related thrombosis: risks, diagnosis, and management

Symptomatic thromboembolic complications of central venous catheters (CVCs) occur in 5% or less of general oncology patients. Asymptomatic CVC-related thrombi are more common, but their clinical significance is unclear. Thrombotic risk may be increased by primary thrombophilic disorders, especially the factor V G1691A (Leiden) mutation, thrombogenic catheter material, larger catheter diameter and greater number of lumens, catheter tip malposition, left-sided placement, percutaneous or multiple insertion attempts, a previous CVC or preexisting venous obstruction, prothrombotic therapeutic agents, catheter-associated infections, and fibrinous catheter lumen occlusion. Three recent randomized, prospective, placebo-controlled trials observed no benefit of routine low-dose warfarin or low-molecular-weight heparin in preventing catheter-associated thrombosis. Nevertheless, thromboprophylaxis may be appropriate and safe for selected high-risk patients. Duplex ultrasound can accurately detect CVC-related thrombi involving the jugular, axillary, distal subclavian, and arm veins. Contrast venographic imaging is required for indeterminate duplex findings and to evaluate the deep central veins and pulmonary arteries. Therapeutic anticoagulation, with or without catheter removal, is indicated for patients with acute deep vein thrombosis (DVT) or pulmonary embolism who have no contraindications. Catheter removal alone, with close follow-up, may be sufficient when bleeding risk precludes safe anticoagulation. Approaches to managing catheter-associated thrombosis, including the use of thrombolytic agents, are guided by limited published experience and extrapolation from practices used for lower-extremity DVT. Prospective, randomized, controlled trials are needed to identify the safest and most effective anticoagulant agents, treatment durations, and alternative venous access strategies for cancer patients who develop catheter-associated thrombosis.