介入放射学技术用于严重血小板减少症患者的端口植入是安全的。

Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology.

作者信息

Keulers Annika R, Kiesow Lilian, Mahnken Andreas H

机构信息

Department of Diagnostic and Interventional Radiology, UKGM University Hospital Marburg, Philipps University Marburg, Baldingerstr. 1, 35043, Marburg, Germany.

Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.

出版信息

Cardiovasc Intervent Radiol. 2018 Jan;41(1):80-86. doi: 10.1007/s00270-017-1794-y. Epub 2017 Sep 13.

DOI:10.1007/s00270-017-1794-y

PMID:28905099

Abstract

PURPOSE

Platelet counts <50/nl are often considered a contraindication for surgical and interventional radiology procedures. Yet, there are patients requiring totally implantable venous access ports (TIVAP) in whom normalization of the coagulation state is not feasible. This retrospective study evaluates the safety of interventional radiological TIVAP implantation in patients with severe thrombocytopenia.

MATERIALS AND METHODS

From 12/2010 to 12/2014, a total 1200 consecutive radiological TIVAP implantations were performed and retrospectively analyzed. Among those 181 patients had platelet counts (PC) below the reference value of 150-350 thrombocytes/nl: 55 patients with mild (PC: 100-150/nl), 58 patients with moderate (PC: 50-100/nl) and 68 patients with severe thrombocytopenia (PC <50/nl). All patients diagnosed with severe thrombocytopenia received platelet concentrates before or during the procedure according to a fixed preparation protocol. All patients were assessed at least 2 weeks before and up to 12 months after intervention. Outcome parameters were recorded with a particular focus on bleeding complications. Data were statistically analyzed with a p value <0.05 considered statistically significant.

RESULTS

The technical success rate for TIVAP implantation was 100%. Patients were followed for a mean of 833 indwelling catheter days in patients with thrombocytopenia (total: 150.923 days) and for 936 indwelling catheter days in patients with normal platelet counts (total: 953.760 days). No significant differences in complication rates between patients with normal platelet counts and patients with mild to severe thrombocytopenia under platelet substitution were found (p > 0.05), especially no bleeding complications occurred during acute, early or late phase.

CONCLUSION

With individualized platelet substitution, patients with severe thrombocytopenia may receive radiological TIVAP implantation without an increased risk of bleeding complications.

LEVEL OF EVIDENCE

IV.

摘要

目的

血小板计数<50/nl通常被视为手术和介入放射学操作的禁忌证。然而，有一些需要完全植入式静脉通路端口（TIVAP）的患者，其凝血状态无法恢复正常。本回顾性研究评估了在严重血小板减少症患者中进行介入放射学TIVAP植入的安全性。

材料与方法

2010年12月至2014年12月，共进行了1200例连续的放射学TIVAP植入，并进行回顾性分析。其中181例患者血小板计数（PC）低于参考值150 - 350/μl：55例轻度血小板减少（PC：100 - 150/μl），58例中度血小板减少（PC：50 - 100/μl），68例严重血小板减少（PC <50/μl）。所有诊断为严重血小板减少症的患者在手术前或手术期间根据固定的制备方案接受血小板浓缩物。所有患者在干预前至少2周和干预后长达12个月进行评估。记录结果参数，特别关注出血并发症。数据进行统计学分析，p值<0.05被认为具有统计学意义。

结果

TIVAP植入的技术成功率为100%。血小板减少症患者的平均随访留置导管天数为833天（总计：150923天），血小板计数正常的患者为936天（总计：953760天）。在血小板替代治疗下，血小板计数正常的患者与轻度至重度血小板减少症患者的并发症发生率无显著差异（p>0.05），尤其是在急性、早期或晚期均未发生出血并发症。