Τίτλος:
International clinical practice guidelines for the treatment and
prophylaxis of thrombosis associated with central venous catheters in
patients with cancer
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
. Background: Although long-term indwelling central venous catheters
(CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is
lack of consensus on management of CVC-related thrombosis (CRT) in
cancer patients and heterogeneity in clinical practices worldwide.
Objectives: To establish common international Good Clinical Practices
Guidelines (GCPG) for the management of CRT in cancer patients. Methods:
An international working group of experts was set up to develop GCPG
according to an evidence-based medicine approach, using the GRADE
system. Results: For the treatment of established CRT in cancer
patients, we found no prospective randomized studies, two non-randomized
prospective studies and one retrospective study examining the efficacy
and safety of low-molecular-weight heparin (LMWH) plus vitamin K
antagonists (VKAs). One retrospective study evaluated the benefit of CVC
removal and two small retrospective studies were on thrombolytic drugs.
For the treatment of symptomatic CRT, anticoagulant treatment (AC) is
recommended for a minimum of 3 months; in this setting, LMWHs are
suggested. VKAs can also be used, in the absence of direct comparisons
of these two types of anticoagulants in this setting [Guidance]. The
CVC can be kept in place if it is functional, well-positioned and
non-infected and there is good resolution under close surveillance;
whether the CVC is kept or removed, no standard approach in terms of AC
duration has been established [Guidance]. For the prophylaxis of CRT
in cancer patients, we found six randomized studies investigating the
efficacy and safety of VKA vs. placebo or no treatment, one on the
efficacy and safety of unfractionnated heparin, six on the value of
LMWH, one double-blind randomized and one non randomized study on
thrombolytic drugs and six meta-analyses of AC and CVC
thromboprophylaxis. Type of catheter (open-ended like the Hickman (R)
catheter vs. closed-ended catheter with a valve like the Groshong (R)
catheter), its position (above, below or at the junction of the superior
vena cava and the right atrium) and method of placement may influence
the onset of CRT on the basis of six retrospective trials, four
prospective non-randomized trials, three randomized trials and one
meta-analysis. In light of these data: use of AC for routine prophylaxis
of CRT is not recommended [1A]; a CVC should be inserted on the right
side, in the jugular vein, and distal extremity of the CVC should be
located at the junction of the superior vena cava and the right atrium
[1A]. Conclusion: Dissemination and implementation of these
international GCPG for the prevention and treatment of CRT in cancer
patients at each national level is a major public health priority,
needing worldwide collaboration.
Συγγραφείς:
Debourdeau, P.
Farge, D.
Beckers, M.
Baglin, C. and
Bauersachs, R. M.
Brenner, B.
Brilhante, D.
Falanga, A. and
Gerotzafias, G. T.
Haim, N.
Kakkar, A. K.
Khorana, A. A. and
Lecumberri, R.
Mandala, M.
Marty, M.
Monreal, M.
Mousa,
S. A.
Noble, S.
Pabinger, I.
Prandoni, P.
Prins, M. H.
and Qari, M. H.
Streiff, M. B.
Syrigos, K.
Buller, H. R. and
Bounameaux, H.
Περιοδικό:
Journal of Thrombosis and Haemostasis
Λέξεις-κλειδιά:
anticoagulant; cancer; catheter; clinical practice guidelines; GRADE
system; thrombosis
