Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, Wuhan, Hubei Province, China.
J Thromb Haemost. 2020 Sep;18(9):2253-2273. doi: 10.1111/jth.14930. Epub 2020 Jul 15.
Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis.
Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE.
In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs.
Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
用于化疗的完全植入式静脉输液港（TIVAP）与静脉血栓栓塞症（VTE）有关。我们旨在通过荟萃分析来量化 TIVAP 相关 VTE 的发生率，并将其与癌症患者的外部中央静脉导管（CVC）进行比较。
从医学文献数据库中检索到报告 TIVAP 相关 VTE 风险的研究。对于没有对照组的出版物，计算了 TIVAP 相关 VTE 的总发生率。对于比较 TIVAP 与外部 CVC 的研究，计算了比值比（OR）来评估 VTE 的风险。
共检索到 80 项研究（11 项具有对照组，69 项无对照组），包括 39148 名患者。在无对照研究中，总症状性 VTE 发生率为 2.76%（95%置信区间[CI]：2.24-3.28），每 1000 个导管日发生 0.08 例（95%CI：0.06-0.10）。当 TIVAP 通过上肢静脉插入时，这种风险最高（3.54%，95%CI：2.94-4.76）。我们对病例对照研究的荟萃分析表明，与外周插入的中央导管（OR=0.20，95%CI：0.09-0.43）相比，TIVAP 与 VTE 风险降低相关，与 Hickman 导管（OR=0.75，95%CI：0.37-1.50）相比，VTE 风险呈下降趋势。Meta 回归模型表明，区域差异可能显著影响与 TIVAP 相关的 VTE 发生率。
目前的证据表明，与外部 CVC 相比，使用 TIVAP 的癌症患者发生 VTE 的可能性较低。在选择化疗用留置静脉装置时应考虑这一点。然而，在选择插入部位时应更加注意上肢静脉。
