Dalteparin for Severe Central Venous Catheter-Related Thrombosis in an Adult with Septic Shock: A Successful Treatment Experience

Abstract

Central venous thrombosis after central venous catheter indwelling is an underestimated complication. There are far fewer reports on the clinical significance of catheter-related thrombosis in septic adults, than in hemato-oncologic, pediatric, and hemodialytic patients. Sepsis has impacts on the systemic coagulation mechanism that differ from the above diseases, and potentiates thrombosis formation. Severe catheter-related thrombosis manifesting as central venous occlusion is very rare. The safety of warfarin, thrombolytic agents, and recombinant human activated protein C in septic patients remains unclear; therefore, the treatment of choice is not well established. With the increased sepsis incidence and widespread use of central venous catheters in these patients, catheter-related thrombosis should be given more attention and discussion. We report a septic shock patient with severe femoral venous thrombosis after central venous catheter implantation. A lower extremity duplex ultrasonogram confirmed the diagnosis. The patient was treated with dalteparin subcutaneously. The endovascular thrombosis resolved completely 7 days later. This treatment experience suggests that dalteparin is safe and cost-effective for catheter-related thrombosis.