血液稀释剂预防中心静脉置管的癌症患者血栓形成

2018-09-30 佚名 BUCM循证医学精视角

中心静脉导管 (CVC) 是插入到大静脉中以提供液体或药物的导管。在癌症患者中,其放置增加了血栓的风险。该系统综述评价了血液稀释剂 (抗凝药) 在放置中心静脉导管的癌症患者中的有效性和安全性

研究背景

中心静脉导管 (CVC) 是插入到大静脉中以提供液体或药物的导管。在癌症患者中,其放置增加了血栓的风险。该系统综述评价了血液稀释剂 (抗凝药) 在放置中心静脉导管的癌症患者中的有效性和安全性。

研究特点

我们在科学文献中检索了抗凝药在放置中心静脉导管的癌症患者中应用的研究。目前证据检索截止到2018年5月14日。

主要结果

我们纳入了13项试验,涉及3420名放置CVC的癌症患者。大多数试验纳入患有不同类型或不同阶段的癌症病人。有7项研究比较了血液稀释注射剂与无抗凝治疗,6项研究比较了血液稀释药丸与无抗凝药物,3项研究比较了血液稀释注射剂与血液稀释药丸。对于放置CVC的癌症患者,注射性血液稀释剂治疗与无抗凝治疗相比可能降低了与CVC相关的血栓的风险,注射性血液稀释剂治疗与血液稀释药丸治疗相比,可能增加了血小板减少的风险 (血液中血小板含量低,会导致组织出血)。

证据质量

当将注射性血液稀释剂与无抗凝治疗进行比较时,我们判断,在导管部位血栓形成的证据确信度为中等,死亡率、导管部位感染和轻微出血等方面为低质量证据,大出血方面的质量非常低。

在比较血液稀释药丸与无抗凝治疗的情况下,我们判断死亡率、轻微出血和大出血为低质量证据,过早导管移除和导管相关感染为低质量证据,导管部位血栓为非常低质量证据。

在将注射用血液稀释剂与血液稀释药丸进行比较时,我们判断,在死亡率和四肢血栓形成方面证据的质量低,导管部位形成血栓、大出血和轻微出血方面证据质量非常低。

结论:

对于 LMWH 对死亡率的影响,VKA 对死亡率和导管相关静脉血栓栓塞的影响,以及 LMWH 与 VKA 相比较对死亡率和导管相关静脉血栓栓塞的影响, 证据并不确凿。中等确信性证据表明,与无 LMWH 相比, LMWH治疗减少了与导管相关的VTE。对于中心静脉置管的癌症患者,应该权衡抗凝治疗减少血栓栓塞并发症的益处和抗凝药可能造成的危害和负担。

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    2019-05-07 fusion
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    2018-12-07 jyzxjiangqin

    血液稀释剂预防中心静脉置管。

    0

  4. 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createdBy=0bc129907796, createdName=fusion, createdTime=Tue May 07 17:00:00 CST 2019, time=2019-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=354758, encodeId=d949354e5833, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Dec 07 17:47:44 CST 2018, time=2018-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353472, encodeId=3aa23534e233, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Nov 23 20:30:57 CST 2018, time=2018-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796986, encodeId=10ac1e96986a9, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Nov 21 22:00:00 CST 2018, time=2018-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350926, encodeId=9ddc350926cb, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 30 07:52:54 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349554, encodeId=3d7f349554ec, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 16 21:03:10 CST 2018, time=2018-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348178, encodeId=6ff03481e829, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Sat Oct 06 09:41:47 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=347764, encodeId=9b6634e7641b, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Oct 03 13:29:12 CST 2018, time=2018-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289615, encodeId=864d12896154b, content=<a href='/topic/show?id=cbb8e1356f7' target=_blank style='color:#2F92EE;'>#癌症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71356, encryptionId=cbb8e1356f7, topicName=癌症患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Tue Oct 02 14:00:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
    2018-11-23 jyzxjiangqin

    血液稀释剂预防中心。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2010743, encodeId=23372010e4304, content=<a href='/topic/show?id=3dfc89322d6' target=_blank style='color:#2F92EE;'>#血液稀释剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89322, encryptionId=3dfc89322d6, topicName=血液稀释剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Tue Jan 08 16:00:00 CST 2019, time=2019-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697769, encodeId=0a2a169e76924, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, 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createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Nov 23 20:30:57 CST 2018, time=2018-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796986, encodeId=10ac1e96986a9, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Nov 21 22:00:00 CST 2018, time=2018-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350926, encodeId=9ddc350926cb, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 30 07:52:54 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349554, encodeId=3d7f349554ec, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 16 21:03:10 CST 2018, time=2018-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348178, encodeId=6ff03481e829, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Sat Oct 06 09:41:47 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=347764, encodeId=9b6634e7641b, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Oct 03 13:29:12 CST 2018, time=2018-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289615, encodeId=864d12896154b, content=<a href='/topic/show?id=cbb8e1356f7' target=_blank style='color:#2F92EE;'>#癌症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71356, encryptionId=cbb8e1356f7, topicName=癌症患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Tue Oct 02 14:00:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2010743, encodeId=23372010e4304, content=<a href='/topic/show?id=3dfc89322d6' target=_blank style='color:#2F92EE;'>#血液稀释剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89322, encryptionId=3dfc89322d6, topicName=血液稀释剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Tue Jan 08 16:00:00 CST 2019, time=2019-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697769, encodeId=0a2a169e76924, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Tue May 07 17:00:00 CST 2019, time=2019-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=354758, encodeId=d949354e5833, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Dec 07 17:47:44 CST 2018, time=2018-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353472, encodeId=3aa23534e233, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Nov 23 20:30:57 CST 2018, time=2018-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796986, encodeId=10ac1e96986a9, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Nov 21 22:00:00 CST 2018, time=2018-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350926, encodeId=9ddc350926cb, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 30 07:52:54 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349554, encodeId=3d7f349554ec, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 16 21:03:10 CST 2018, time=2018-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348178, encodeId=6ff03481e829, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Sat Oct 06 09:41:47 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=347764, encodeId=9b6634e7641b, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Oct 03 13:29:12 CST 2018, time=2018-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289615, encodeId=864d12896154b, content=<a href='/topic/show?id=cbb8e1356f7' target=_blank style='color:#2F92EE;'>#癌症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71356, encryptionId=cbb8e1356f7, topicName=癌症患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Tue Oct 02 14:00:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
    2018-10-30 jyzxjiangqin

    血液稀释剂预防中心静脉置管。

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2010743, encodeId=23372010e4304, content=<a href='/topic/show?id=3dfc89322d6' target=_blank style='color:#2F92EE;'>#血液稀释剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89322, encryptionId=3dfc89322d6, topicName=血液稀释剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Tue Jan 08 16:00:00 CST 2019, time=2019-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697769, encodeId=0a2a169e76924, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, 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createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Nov 23 20:30:57 CST 2018, time=2018-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796986, encodeId=10ac1e96986a9, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Nov 21 22:00:00 CST 2018, time=2018-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350926, encodeId=9ddc350926cb, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 30 07:52:54 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=349554, encodeId=3d7f349554ec, content=血液稀释剂预防中心。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 16 21:03:10 CST 2018, time=2018-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348178, encodeId=6ff03481e829, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Sat Oct 06 09:41:47 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=347764, encodeId=9b6634e7641b, content=血液稀释剂预防中心静脉置管。, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Wed Oct 03 13:29:12 CST 2018, time=2018-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289615, encodeId=864d12896154b, content=<a href='/topic/show?id=cbb8e1356f7' target=_blank style='color:#2F92EE;'>#癌症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71356, encryptionId=cbb8e1356f7, topicName=癌症患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Tue Oct 02 14:00:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
    2018-10-16 jyzxjiangqin

    血液稀释剂预防中心。

    0

  8. 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topicName=癌症患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Tue Oct 02 14:00:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
    2018-10-06 phoebeyan520

    学习了

    0

  9. 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    2018-10-03 jyzxjiangqin

    血液稀释剂预防中心静脉置管。

    0

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