Gould J R, Carloss H W, Skinner W L
West Kentucky Hematology/Oncology Group, Paducah 42001.
Am J Med. 1993 Oct;95(4):419-23. doi: 10.1016/0002-9343(93)90312-d.
To identify factors associated with the development of clinically significant venous thrombosis in cancer patients with long-term indwelling subclavian Groshong catheters (GC). Also, to assess both the subsequent performance of affected catheters and the effect of heparin and warfarin therapy on subsequent catheter function and longevity.
Longitudinal study of the outcome of clinical practice. Subset analysis of those catheters developing catheter-related venous thrombosis (CRVT).
Thirty-seven cases of CRVT were identified in a population of 255 consecutive patients in whom a GC was inserted. Seventy percent of the thrombi occurred after an episode of previous catheter dysfunction; only 30% of the thrombi occurred de novo. An unexpectedly high risk of thrombosis was associated with insertion into the left-subclavian circulation (25 of 35 versus 135 of 220, p = 0.02) or with an antecedent episode of aspiration difficulty ("ball-valve effect" [BVE]) (20 of 35 versus 60 of 220, p < 0.01). No correlation was identified between thrombosis and tumor type, tumor histology, or preexisting medical disorders. Once identified, 79% of the involved patients received anticoagulant therapy with sequential heparin and warfarin. Overall longevity of the catheters preserved by anticoagulation (mean dwell = 202 days) far exceeded catheter longevity among the population of catheters that never developed thrombosis (mean dwell = 142 days). The mean catheter longevity after thrombosis (169 days) also exceeded the mean dwell time of all other catheters that were complication-free.
CRVT is more likely in patients in whom the catheter is inserted in the left-subclavian circulation or who have experienced a previous episode of aspiration difficulty with the catheter (BVE). Catheter preservation with sequential heparin and warfarin therapy precludes the need for catheter removal and extends dramatically the useful life of the catheter.
确定长期留置锁骨下Groshong导管（GC）的癌症患者发生具有临床意义的静脉血栓形成的相关因素。此外，评估受影响导管的后续性能以及肝素和华法林治疗对后续导管功能和使用寿命的影响。
对临床实践结果进行纵向研究。对发生导管相关静脉血栓形成（CRVT）的导管进行亚组分析。
在连续255例插入GC的患者中，共识别出37例CRVT。70%的血栓发生在先前导管功能障碍发作之后；只有30%的血栓是新发的。血栓形成风险意外地高与插入左锁骨下循环（35例中的25例对220例中的135例，p = 0.02）或先前有抽吸困难发作（“球阀效应”[BVE]）（35例中的20例对220例中的60例，p < 0.01）有关。未发现血栓形成与肿瘤类型、肿瘤组织学或既往疾病之间存在相关性。一旦确诊，79%的受累患者接受了肝素和华法林序贯抗凝治疗。通过抗凝保留的导管总体使用寿命（平均留置时间 = 202天）远远超过未发生血栓形成的导管人群中的导管使用寿命（平均留置时间 = 142天）。血栓形成后导管的平均使用寿命（169天）也超过了所有其他无并发症导管的平均留置时间。
导管插入左锁骨下循环的患者或先前有导管抽吸困难发作（BVE）的患者发生CRVT的可能性更大。肝素和华法林序贯治疗保留导管可避免导管拔除的需要，并显著延长导管的使用寿命。
