Zellweger Michael, Bouchard Josée, Raymond-Carrier Stéphanie, Laforest-Renald Alexandra, Quérin Serge, Madore François
Service de Néphrologie, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.
ASAIO J. 2005 Jul-Aug;51(4):360-5. doi: 10.1097/01.mat.0000169115.56374.9f.
Although chronic anticoagulation is commonly prescribed to prevent thrombosis and malfunction of hemodialysis tunneled cuffed catheters (TCC), there are only limited data regarding its efficacy. The aim of this prospective study was to evaluate whether anticoagulation with adjusted-dose warfarin targeting an international normalized ratio (INR) of 1.5-2.0 is associated with improved catheter outcome in long-term patients at high risk of TCC malfunction. Among the 65 patients included in the study, 35 were considered at high risk (i.e., patients with a history of previous TCC thrombosis requiring catheter replacement and/or with TCC malfunction occurring within 2 weeks after catheter insertion in the absence of mechanical problems) and were prescribed warfarin, whereas 30 low-risk patients did not receive anticoagulation. During follow-up, TCC malfunction, defined as the need for inversion of catheter lines and/or recombinant tissue-type plasminogen activator infusion, was observed in 61.5% of patients. Among patients receiving warfarin, 19 (54.3%) achieved adequate anticoagulation (i.e., > 80% of follow-up INR values and INR value at the time of malfunction within target range). Anticoagulation was considered inadequate in 16 patients (45.7%). Malfunction-free catheter survival at 9 months was 47.1% in patients with adequate anticoagulation compared with 8.1% in patients with inadequate anticoagulation (p = 0.01). This difference remained statistically significant after adjustment for aspirin intake. These results suggest that achieving adequate anticoagulation with target INR 1.5-2.0 may prevent TCC malfunction and improve catheter outcome.
尽管慢性抗凝治疗常用于预防血液透析带隧道涤纶套导管（TCC）的血栓形成和功能障碍，但关于其疗效的数据有限。这项前瞻性研究的目的是评估以国际标准化比值（INR）为1.5 - 2.0的调整剂量华法林进行抗凝治疗，是否与长期存在TCC功能障碍高风险患者的导管预后改善相关。在纳入研究的65例患者中，35例被认为是高风险患者（即有既往TCC血栓形成病史需要更换导管和/或在无机械问题的情况下，导管插入后2周内发生TCC功能障碍的患者）并接受华法林治疗，而30例低风险患者未接受抗凝治疗。在随访期间，61.5%的患者出现了TCC功能障碍，定义为需要反转导管线路和/或输注重组组织型纤溶酶原激活剂。在接受华法林治疗的患者中，19例（54.3%）实现了充分抗凝（即随访期间> 80%的INR值以及功能障碍时的INR值在目标范围内）。16例患者（45.7%）的抗凝治疗被认为不充分。充分抗凝患者9个月时无功能障碍的导管存活率为47.1%，而抗凝不充分患者为8.1%（p = 0.01）。在调整阿司匹林摄入情况后，这种差异仍具有统计学意义。这些结果表明，实现目标INR为1.5 - 2.0的充分抗凝可能预防TCC功能障碍并改善导管预后。
