Blood Research Institute, Versiti, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Thromb Res. 2021 Jun;202:155-161. doi: 10.1016/j.thromres.2021.03.021. Epub 2021 Apr 6.
Optimal treatment of catheter-related thrombosis (CRT) is uncertain in patients with hematologic malignancy. We aimed to evaluate the treatment strategies, outcomes, and predictors of recurrent venous thromboembolism (VTE) associated with catheter-related thrombosis (CRT) in patients with hematologic malignancy.
We performed a multicenter retrospective cohort study of eight institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies with documented CRT were identified using ICD-9 and ICD-10 diagnostic codes. Semi-competing risks proportional hazard regression models were created.
Of the 663 patients in the cohort, 124 (19%) were treated with anticoagulation alone, 388 (58%) were treated with anticoagulation and catheter removal, 119 (18%) treated with catheter removal only, and 32 (5%) had neither catheter removal nor anticoagulation. 100 (15%) patients experienced a recurrent VTE event. In the 579 patients who had catheter removal, the most common reason for catheter removal was the CRT [392 (68%)]. For subjects who received any anticoagulation (n = 512), total anticoagulation duration was not associated with VTE recurrence [1.000 (0.999-1.002)]. After adjustment patients treated with catheter removal only had an increased risk of VTE recurrence [2.50 (1.24-5.07)] and death [4.96 (2.47-9.97)]. Patients with no treatment had increased risk of death [16.81 (6.22-45.38)] and death after VTE recurrence [27.29 (3.13-238.13)]. In this large, multicenter retrospective cohort, we found significant variability in the treatment of CRT in patients with hematologic malignancy. Treatment without anticoagulation was associated with recurrent VTE.
在血液恶性肿瘤患者中，导管相关性血栓（CRT）的最佳治疗方法尚不确定。我们旨在评估血液恶性肿瘤患者 CRT 相关静脉血栓栓塞症（VTE）的治疗策略、结局和复发预测因素。
我们通过美国静脉血栓栓塞网络（Venous thromboEmbolism Network US）对 8 家机构进行了一项多中心回顾性队列研究。使用 ICD-9 和 ICD-10 诊断代码确定有 CRT 记录的血液恶性肿瘤患者。建立半竞争风险比例风险回归模型。
在队列中的 663 名患者中，124 名（19%）仅接受抗凝治疗，388 名（58%）接受抗凝和导管去除治疗，119 名（18%）仅接受导管去除治疗，32 名（5%）既未接受导管去除也未接受抗凝治疗。100 名（15%）患者发生了复发性 VTE 事件。在 579 名接受导管去除的患者中，最常见的导管去除原因是 CRT[392（68%）]。对于接受任何抗凝治疗的患者（n=512），总抗凝持续时间与 VTE 复发无关[1.000（0.999-1.002)]。调整后，仅接受导管去除治疗的患者 VTE 复发风险增加[2.50（1.24-5.07)]和死亡风险增加[4.96（2.47-9.97)]。未治疗的患者死亡风险增加[16.81（6.22-45.38)]和 VTE 复发后死亡风险增加[27.29（3.13-238.13)]。在这项大型多中心回顾性队列研究中，我们发现血液恶性肿瘤患者 CRT 治疗存在显著差异。无抗凝治疗与复发性 VTE 相关。
