Colì L, Donati G, Cianciolo G, Raimondi C, Comai G, Panicali L, Nastasi V, Cannarile D C, Gozzetti F, Piccari M, Stefoni S
Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna , Italy.
J Vasc Access. 2006 Jul-Sep;7(3):118-22. doi: 10.1177/112972980600700305.
Chronic oral anticoagulation is currently used to avoid thrombosis and the malfunction of tunneled cuffed catheters (TCCs) for hemodialysis (HD). The aim of the study was to assess the efficacy of early warfarin administration, after TCC placement, in comparison to its administration after the first thrombosis or malfunction event of the TCC.
One hundred and forty-four chronic dialysis patients, who underwent TCC placement between June 2001 and June 2005, were randomized into two groups: 81 patients, group A, started oral anticoagulation 12 hr after the TCC placement (target international normalized ratio (INR) 1.8-2.5), in association with ticlopidine 250 mg/die; 63 patients, group B, started warfarin after the first thrombosis/malfunction episode (target INR 1.8-2.5) in association with ticlopidine 250 mg/die. The efficacy of oral anticoagulation therapy in preventing TCC thrombotic complications was evaluated in a 12-month follow-up period, after TCC placement, in terms of: a) the number of patients with thrombotic-malfunction events; b) the number of thrombotic-malfunction events with urokinase infusion (events/patient/year); c) intradialytic blood flow rate (BFR, ml/min); d) negative blood pressure (BP) from the arterial line of the TCC (AP, mmHg); e) positive BP, in the extracorporeal circuit from the venous line (VP, mmHg); and f) bleeding complications.
Ten patients (12%) in group A showed TCC thrombosis/malfunction vs. 33 patients (52%) in group B (p < 0.01). In group A, 0.16 events of thrombosis/malfunction per patient/year vs. 1.65 in group B (p < 0.001) were ob-served. BFR was respectively 305 +/- 34 vs. 246 +/- 42 ml/min (p < 0.001). AP was -124 +/- 13 in group A vs. -174 +/- 21 mmHg in group B (p < 0.05). VP was 112 +/- 28 in group A vs. 168 +/- 41 mmHg in group B (p < 0.05). No patient showed any bleeding events.
Early warfarin therapy allows a significant reduction in TCC thrombotic complications and an improvement in both arterial and venous fluxes in comparison with the same therapy administered after the first TCC thrombotic/malfunction event. This therapy did not induce any bleeding complications in the patients included in the study.
目前，慢性口服抗凝治疗用于预防血栓形成以及血液透析（HD）用带袖套隧道式中心静脉导管（TCC）的功能障碍。本研究的目的是评估TCC置入后早期给予华法林与在TCC首次发生血栓形成或功能障碍事件后给予华法林相比的疗效。
144例在2001年6月至2005年6月期间接受TCC置入的慢性透析患者被随机分为两组：A组81例患者在TCC置入后12小时开始口服抗凝治疗（目标国际标准化比值（INR）为1.8 - 2.5），并联合使用噻氯匹定250mg/日；B组63例患者在首次发生血栓形成/功能障碍事件后开始使用华法林（目标INR为1.8 - 2.5），并联合使用噻氯匹定250mg/日。在TCC置入后的12个月随访期内，从以下方面评估口服抗凝治疗预防TCC血栓形成并发症的疗效：a）发生血栓形成 - 功能障碍事件的患者数量；b）接受尿激酶输注的血栓形成 - 功能障碍事件数量（事件/患者/年）；c）透析过程中的血流量（BFR，ml/分钟）；d）TCC动脉端的负血压（AP，mmHg）；e）体外循环中静脉端的正血压（VP，mmHg）；f）出血并发症。
A组有10例患者（12%）出现TCC血栓形成/功能障碍，而B组有33例患者（52%）出现（p < 0.01）。A组每位患者每年发生血栓形成/功能障碍的事件为0.16次，而B组为1.65次（p < 0.001）。血流量分别为305±34ml/分钟和246±42ml/分钟（p < 0.001）。A组的AP为 - 124±13mmHg，B组为 - 174±21mmHg（p < 0.05）。A组的VP为112±28mmHg，B组为168±41mmHg（p < 0.05）。没有患者出现任何出血事件。
与在TCC首次发生血栓形成/功能障碍事件后给予相同治疗相比，早期华法林治疗可显著减少TCC血栓形成并发症，并改善动静脉血流量。该治疗在本研究纳入的患者中未引发任何出血并发症。
