Macdougall L, Hanley J, Mountford C, Thompson N P
Deptartment of Gastroenterology, Newcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK.
Department of HaematologyNewcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK.
Frontline Gastroenterol. 2017 Jul;8(3):163-166. doi: 10.1136/flgastro-2015-100665. Epub 2017 Jan 6.
Maintaining central access is imperative for the delivery of home parenteral nutrition (HPN) in those with intestinal failure. Methods to reduce central venous catheter infection are well recognised; however, the prevention of line thrombosis is less well studied.
This paper reviews the current evidence and reports a survey of current practice within the UK. Using an electronic survey, respondents were asked to detail their use of anticoagulation in different patient groups and the type of anticoagulation used.
41 replies were received from 31 centres. Only one responder used low-dose warfarin routinely; 80% however anticoagulated those with a previous line thrombosis and 65% anticoagulated those that had any deep vein thrombosis or pulmonary embolus. The most commonly used anticoagulant was dose-adjusted warfarin aiming for an international normalised ratio of 2-3.
The evidence from the current literature in both HPN and the wider field is that there is no clear evidence that anticoagulation is either beneficial or harmful in the prevention of line thrombosis. This survey suggested that practice is varied across the UK likely reflecting the lack of evidence within the current literature.
对于肠衰竭患者，维持中心静脉通路对于家庭肠外营养（HPN）的实施至关重要。减少中心静脉导管感染的方法已广为人知；然而，预防导管血栓形成的研究较少。
本文回顾了当前证据，并报告了一项关于英国当前实践的调查。通过电子调查，要求受访者详细说明他们在不同患者群体中使用抗凝治疗的情况以及所使用的抗凝类型。
收到了来自31个中心的41份回复。只有一名受访者常规使用低剂量华法林；然而，80%的受访者对既往有导管血栓形成的患者进行抗凝治疗，65%的受访者对有任何深静脉血栓形成或肺栓塞的患者进行抗凝治疗。最常用的抗凝剂是剂量调整的华法林，目标国际标准化比值为2 - 3。
当前HPN及更广泛领域的文献证据表明，没有明确证据表明抗凝在预防导管血栓形成方面是有益还是有害。这项调查表明，英国各地的实践各不相同，这可能反映了当前文献中缺乏证据。
