Tran Minh-Ha, Wilcox Tanya, Tran Phu N
Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA.
Department of Internal Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA.
J Vasc Access. 2020 May;21(3):300-307. doi: 10.1177/1129729819873851. Epub 2019 Sep 25.
Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT).
To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups.
A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients - 12 (4.0-24.0) weeks compared to 5.5 (1.8-16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position - 27/34 (79.4%) - overshadowed thrombophilia - 16/63 (25.4%) - as a risk factor for CRAT.
Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.
导管相关右心房血栓形成是中心静脉置管一种未被充分认识的并发症。我们进行了一项回顾性研究，以描述导管相关右心房血栓形成（CRAT）的临床特征。
为确定病例，我们在PubMed上进行了文献检索，并通过回顾相关条目和参考文献综述选择了其他条目。提取关键临床数据并进行总体分析，同时按血液透析组与非血液透析组进行分层分析。
63例患者共报告了68例导管相关右心房血栓形成事件（5例复发，其中4例在初次治疗后导管仍留在原位）。血液透析患者CRAT诊断的中位（四分位间距）时间较长——为12（4.0 - 24.0）周，而非血液透析患者为5.5（1.8 - 16.1）周。最常见的表现为无症状，16/68例（23.5%）；发热/脓毒症，21/68例（30.9%）；肺栓塞，11/68例（16.2%）；导管功能障碍，8/68例（11.8%）；呼吸困难，8/68例（11.8%）；新发杂音或瓣膜功能障碍，8/68例（11.8%）。33/68例（4
