Тромботические наложения на центральных венозных катетерах как фактор риска развития катетер-ассоциированных тромбозов глубоких вен

Abstract

Presence of central vein catheter (CVC) is well known as a risk factor for deep vein thrombosis (DVT) incidence especially in patients with malignancies. The term «CVC-related thrombosis»is attributed to mural thrombosis that involves CVC and adheres to vessel wall. However, presence of CVC in a central vein may result in emerging not only «true»mural thrombosis but so-called _ fibrin sheaths (FS) that envelope CVC but do not involve venous wall. Despite high FS incidence data on its clinical importance are scarce. We investigate FS significance for subsequent DVT appearance. Patients and methods. We analyzed data on 182 CVC inserted in 113 patients aged from 1 to 19 years suffering from ALL. Data were collected retrospectively from electronic hospital charts. The diagnosis of DVT and FS was made by means of echocardiography (ECHO) and Doppler ultrasound scanning (DUS) of brachiocephalic veins. DUS has been performed at different time after CVC implantation depending on clinical indications and physician's opinion. Results. Incidence of FS was 2,71 events per 1000 catheter days. Presence of FS was significantly associated with DVT incidence (odds ratio (OR) 2,75, 95% confidential interval (CI) 1,32-5,74, р = 0,003). FS resolution occurred independently of anticoagulant usage (р = 0,598). Difference in DVT incidence between groups with and without anticoagulant prophylaxis after FS detecting was statistically insignificant (р = 0,908). Discussion. According to our data, FS were detected on 35% of CVC. Presence of FS was associated with CVC-related DVT incidence. Efficiency of anticoagulants for FS resolving is doubtful. The question whether anticoagulant prophylaxis of DVT should be started after FS detecting remains open. Large prospective studies are required to resolve this issue.