Porfidia Angelo, Cammà Giulia, Coletta Nicola, Bigossi Margherita, Giarretta Igor, Lupascu Andrea, Scaletta Giuseppe, Porceddu Enrica, Tondi Paolo, Scambia Giovanni, Ferrandina Gabriella, Pola Roberto
Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Front Cardiovasc Med. 2022 Jun 28;9:880698. doi: 10.3389/fcvm.2022.880698. eCollection 2022.
Catheter-related thrombosis (CRT) of the upper extremities is a frequent complication among cancer patients that carry a central venous catheter (CVC) and may lead to pulmonary embolism (PE) and loss of CVC function. Despite its clinical impact, no anticoagulant treatment scheme has been rigorously evaluated in these patients. In addition, there is no proven evidence that direct oral anticoagulants (DOACs) are efficacious and safe in this setting because cancer patients with CRT of the upper extremities were not included in the clinical trials that led to the approval of DOACs for the treatment of cancer-associated venous thromboembolism (VTE).
We performed a single center retrospective cohort study on women with gynecologic or breast cancer treated with either low-molecular-weight heparin, fondaparinux, or DOACs for CRT of the upper extremities. Only patients who received anticoagulation at the proper therapeutic dose and for at least 3 months were included in the analysis. Effectiveness was evaluated in terms of preservation of line function, residual thrombosis, and recurrence of VTE (including PE). Safety was evaluated in terms of death, major bleeding (MB), and clinically relevant non-major bleeding (CRNMB).
We identified 74 women who fulfilled the criteria to be included in the analysis. Of these, 31 (41.9%) had been treated with fondaparinux, 21 (28.4%) with enoxaparin, and 22 (29.7%) with the DOAC edoxaban. We found no differences between patients treated with the three different therapeutic approaches, in terms of preservation of line function, incidence of residual thrombosis, and VTE recurrence (including PE). Safety was similar as well, with no MBs recorded in any treatment group.
These results, although retrospective and based on a relatively small sample size, indicate that, in women with gynecologic or breast cancer, CRT of the upper extremities may be treated with similar effectiveness and safety with fondaparinux, enoxaparin, and edoxaban. Further studies are needed to substantiate these findings.
上肢导管相关血栓形成（CRT）是携带中心静脉导管（CVC）的癌症患者中常见的并发症，可能导致肺栓塞（PE）和CVC功能丧失。尽管其具有临床影响，但尚未在这些患者中对任何抗凝治疗方案进行严格评估。此外，没有确凿证据表明直接口服抗凝剂（DOACs）在这种情况下有效且安全，因为导致DOACs被批准用于治疗癌症相关静脉血栓栓塞（VTE）的临床试验未纳入患有上肢CRT的癌症患者。
我们对接受低分子量肝素、磺达肝癸钠或DOACs治疗上肢CRT的妇科或乳腺癌女性患者进行了单中心回顾性队列研究。仅将接受适当治疗剂量抗凝且至少3个月的患者纳入分析。从导管功能保留、残余血栓形成和VTE复发（包括PE）方面评估有效性。从死亡、大出血（MB）和临床相关非大出血（CRNMB）方面评估安全性。
我们确定了74名符合纳入分析标准的女性。其中，31名（41.9%）接受了磺达肝癸钠治疗，21名（28.4%）接受了依诺肝素治疗，22名（29.7%）接受了DOAC阿哌沙班治疗。我们发现，在接受三种不同治疗方法的患者之间，在导管功能保留、残余血栓形成发生率和VTE复发（包括PE）方面没有差异。安全性也相似，任何治疗组均未记录到大出血。
这些结果虽然是回顾性的且基于相对较小的样本量，但表明在患有妇科或乳腺癌的女性中，上肢CRT使用磺达肝癸钠、依诺肝素和阿哌沙班治疗可能具有相似的有效性和安全性。需要进一步研究来证实这些发现。
