Verso Melina, Agnelli Giancarlo, Kamphuisen Pieter W, Ageno Walter, Bazzan Mario, Lazzaro Antonio, Paoletti Francesco, Paciaroni Maurizio, Mosca Stefano, Bertoglio Sergio
Dipartimento di Medicina Interna, Università di Perugia, Perugia, Italy.
Intern Emerg Med. 2008 Jun;3(2):117-22. doi: 10.1007/s11739-008-0125-3. Epub 2008 Mar 4.
Deep vein thrombosis of upper limb is a common complication of CVC in patients with cancer. In these patients the risk factors for CVC-related thrombosis are not completely defined. The purpose of this study was to identify the risk factors for CVC-related thrombosis in patients included in a randomized, double-blind, placebo-controlled study aimed at assessing the efficacy and safety of enoxaparin for the prophylaxis of CVC-related thrombosis. CVC-related thrombosis was screened by mandatory venography after 6 weeks of study treatment. A number of patient baseline characteristics were assessed as potential risk factors for CVC-related deep vein thrombosis. Crude associations between risk factors and clinical outcomes were assessed by chi(2) test or Fisher's exact test. Multiple logistic regression analysis was used to identify independent risk factors. A CVC-related thrombosis was found in 50 out of 310 patients (16.1%). At multiple logistic regression analysis, CVC tip misplaced in the upper half of superior vena cava (OR 4.05, 95%CI 1.64-10.02), left-sided CVC insertion (OR 2.29, 95%CI 1.01-5.51) and chest radiotherapy (OR 7.01, 95%CI 1.42-34.66) were independent risk factors for thrombosis. In addition to these risk factors, the presence of distant metastases (OR 9.36, 95%CI 1.53-57.05) increased the risk of thrombosis in patients who received placebo. An inadequate position of the CVC tip, left-sided CVC insertion and chest radiotherapy are independent risk factors for CVC-related thrombosis in cancer patients. Patients with distant metastases have an increased risk for thrombosis in absence of antithrombotic prophylaxis.
上肢深静脉血栓形成是癌症患者中心静脉导管（CVC）的常见并发症。在这些患者中，与CVC相关的血栓形成的危险因素尚未完全明确。本研究的目的是确定纳入一项随机、双盲、安慰剂对照研究的患者中与CVC相关的血栓形成的危险因素，该研究旨在评估依诺肝素预防CVC相关血栓形成的疗效和安全性。在研究治疗6周后通过强制性静脉造影筛查与CVC相关的血栓形成。评估了许多患者基线特征作为与CVC相关的深静脉血栓形成的潜在危险因素。通过卡方检验或Fisher精确检验评估危险因素与临床结局之间的粗略关联。使用多因素逻辑回归分析来确定独立危险因素。310例患者中有50例（16.1%）发生了与CVC相关的血栓形成。在多因素逻辑回归分析中，CVC尖端误置于上腔静脉上半部分（比值比[OR]4.05，95%置信区间[CI]1.64 - 10.02）、左侧CVC置入（OR 2.29，95%CI 1.01 - 5.51）和胸部放疗（OR 7.01，95%CI 1.42 - 34.66）是血栓形成的独立危险因素。除这些危险因素外，远处转移的存在（OR 9.36，95%CI 1.53 - 57.05）增加了接受安慰剂治疗患者的血栓形成风险。CVC尖端位置不当、左侧CVC置入和胸部放疗是癌症患者中与CVC相关的血栓形成的独立危险因素。在没有抗血栓预防的情况下，有远处转移的患者血栓形成风险增加。
