Division of Vascular Medicine, Department of Cardiovascular Diseases and Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Rochester, MN.
Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Blood Adv. 2021 Jul 27;5(14):2807-2812. doi: 10.1182/bloodadvances.2021004698.
Standard treatment of catheter-associated upper extremity deep vein thrombosis (UE-DVT) is anticoagulation, although catheters are often removed for this indication. The optimal time for catheter removal and whether the act and/or timing of catheter removal is associated with pulmonary embolism (PE) remain unknown. A retrospective cohort study was performed at 8 participating institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies and central venous catheter (CVC)-associated UE-DVT were included from 1 January 2010 through 31 December 2016. The primary outcome was objectively confirmed PE within 7 days of UE-DVT diagnosis in anticoagulated patients comparing early (≤48 hours) vs delayed (>48 hours) catheter removal. A total of 626 patients were included, among whom 480 were treated with anticoagulation. Among anticoagulated patients, 255 underwent early CVC removal, while 225 had delayed or no CVC removal; 146 patients received no anticoagulation, among whom 116 underwent CVC removal alone. PE within 7 days occurred in 2 patients (0.78%) with early removal compared with 1 patient (0.44%) with delayed or no CVC removal (P > .9). PE or any cause of death within 7 days occurred in 3 patients in both the early removal (1.18%) and delayed/no removal (1.33%) groups (P > .9). In patients treated with CVC removal only (no anticoagulation), there were no PEs but 3 deaths within 7 days. In patients with hematological malignancy and CVC-associated UE-DVT, early removal of CVCs was not associated with an increased risk of PE compared with delayed or no removal.
标准治疗导管相关上肢深静脉血栓形成（UE-DVT）是抗凝治疗，尽管出于这一适应证通常会移除导管。导管移除的最佳时间以及导管移除的行为和/或时间是否与肺栓塞（PE）相关仍然未知。通过静脉血栓栓塞网络美国的 8 个参与机构进行了一项回顾性队列研究。纳入 2010 年 1 月 1 日至 2016 年 12 月 31 日期间患有血液恶性肿瘤和中心静脉导管（CVC）相关 UE-DVT 的患者。主要结局是在接受抗凝治疗的患者中，比较 UE-DVT 诊断后 7 天内早期（≤48 小时）与晚期（>48 小时）导管移除时，经客观证实的 PE。共纳入 626 例患者，其中 480 例接受抗凝治疗。在接受抗凝治疗的患者中，255 例行早期 CVC 移除，225 例行晚期或无 CVC 移除；146 例未接受抗凝治疗，其中 116 例单独行 CVC 移除。早期移除组有 2 例（0.78%）发生 7 天内 PE，而晚期或无 CVC 移除组有 1 例（0.44%）发生 PE（P>.9）。早期移除组（1.18%）和晚期/无移除组（1.33%）各有 3 例患者在 7 天内发生 PE 或任何原因导致的死亡（P>.9）。仅行 CVC 移除（未抗凝）的患者中，7 天内无 PE，但有 3 例死亡。在患有血液恶性肿瘤和 CVC 相关 UE-DVT 的患者中，与晚期或无 CVC 移除相比，早期移除 CVC 与 PE 风险增加无关。
