Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Hematology Am Soc Hematol Educ Program. 2012;2012:638-44. doi: 10.1182/asheducation-2012.1.638.
Central venous catheters (CVCs) are used extensively in cancer patients for the administration of therapy and phlebotomy. An important complication of CVCs is the development of catheter-related thrombosis (CRT), which becomes symptomatic in approximately 5% of the patients. Several factors, such as insertion location and position of the catheter tip, increase the risk of CRT. Prevention of CRT with systemic anticoagulant prophylaxis has largely been ineffective. In addition, the optimal diagnostic strategy and anticoagulant treatment are unclear due to the lack of well-designed studies. The most recent American College of Chest Physicians guidelines recommend (color) Doppler ultrasound more than venography as the initial diagnostic test in patients with suspected arm thrombosis. Only if the ultrasound is negative and clinical suspicion is high is further testing with D-dimer, serial ultrasound, or venography advocated. In case of CRT, removal of the catheter is not necessary if it is functional and needed for chemotherapy. Anticoagulant treatment of CRT consists of treatment with low-molecular-weight heparin (LMWH) followed by vitamin K antagonists for at least 3 months. Whether long-term treatment with LMWH is more effective than vitamin K antagonists in cancer patients with CRT is unknown, but LMWH may be advocated following the recommendations in lower limb thrombosis and cancer. In addition, the effect of new anticoagulants in CRT has not been studied.
中心静脉导管（CVC）在癌症患者中广泛用于治疗和采血。CVC 的一个重要并发症是导管相关性血栓形成（CRT），大约 5%的患者会出现症状。一些因素，如插入位置和导管尖端的位置，会增加 CRT 的风险。全身性抗凝预防对 CRT 的预防作用在很大程度上并不有效。此外，由于缺乏精心设计的研究，最佳的诊断策略和抗凝治疗尚不清楚。最近的美国胸科医师学会指南建议（彩色）多普勒超声比静脉造影更适合作为疑似手臂血栓形成患者的初始诊断试验。只有当超声检查阴性且临床怀疑度高时，才建议进一步进行 D-二聚体、连续超声或静脉造影检查。如果 CRT 导管仍具有功能且对化疗有需求，则无需移除导管。CRT 的抗凝治疗包括使用低分子肝素（LMWH）治疗，然后至少使用维生素 K 拮抗剂治疗 3 个月。对于 CRT 的癌症患者，LMWH 的长期治疗是否比维生素 K 拮抗剂更有效尚不清楚，但根据下肢血栓形成和癌症的建议，LMWH 可能更受推崇。此外，新型抗凝剂在 CRT 中的疗效尚未得到研究。
