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Thrombosis Prophylaxis in Patient Populations With a Central Venous Catheter
A Systematic Review
Clara P. W. Klerk, MD;
Susanne M. Smorenburg, MD, PhD;
Harry R. Büller, MD, PhD
Arch Intern Med. 2003;163:1913-1921.
Background Central venous catheters (CVCs) are used in a wide variety of patients. Associated complications are thrombosis and infection. It is a matter of debate whether thromboprophylaxis is beneficial.
Methods We performed a systematic review of 3 different patient populations to render the available information in the literature more accessible to clinical practice: patients receiving parenteral nutrition (PN), patients with cancer, and patients admitted to intensive care units.
Results Prophylaxis with heparin added to PN was found to give a nonsignificant reduction in the incidence of catheter-related thrombosis (pooled relative risk of randomized studies, 0.77; 95% confidence interval [CI], 0.11-5.48). In cancer patients, both low-dose warfarin and low-molecular-weight heparin significantly reduced the incidence of catheter-related thrombosis (relative risk of randomized studies, 0.25 [95% CI, 0.09-0.70] and 0.10 [95% CI, 0.01-0.71], respectively). So far, intensive care patients have hardly been studied with respect to thromboprophylaxis and the incidence of CVC thrombosis. Any effect of the type of catheter could not be established because of small numbers. There was no apparent increase in bleeding events with prophylactic anticoagulation in patients with CVCs.
Conclusions In the small number of patients studied, the addition of heparin to PN did not significantly decrease the risk of cathether-related thrombosis, whereas warfarin and dalteparin did decrease the thrombosis risk in cancer patients with CVCs. There is no apparent increase in bleeding events with prophylactic anticoagulants in patients with CVCs.
From the Departments of Internal Medicine (Drs Klerk and Smorenburg), Cell Biology (Drs Klerk and Smorenburg), and Vascular Medicine (Drs Klerk, Smorenburg, and Büller), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. The authors have no relevant financial interest in this article.
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