Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer

被引:241
作者
Couban, S
Goodyear, M
Burnell, M
Dolan, S
Wasi, P
Barnes, D
MacLeod, D
Burton, E
Andreou, P
Anderson, DR
机构
[1] Queen Elizabeth 11 Hlth Sci Ctr, Dept Med, Halifax, NS B3H 2Y9, Canada
[2] Dalhousie Univ, Dept Med, Halifax, NS B3H 3J5, Canada
[3] Dalhousie Univ, Dept Community Hlth & Epidemiol, Halifax, NS B3H 3J5, Canada
[4] Dalhousie Univ, Dept Radiol, Halifax, NS B3H 3J5, Canada
[5] St Johns Reg Hosp, Dept Oncol, St John, NB, Canada
[6] McMaster Univ, Dept Med, Hamilton, ON, Canada
关键词
D O I
10.1200/JCO.2005.10.192
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose In this multicenter, randomized, placebo-controlled clinical trial, we studied whether warfarin 1 mg daily reduces the incidence of symptomatic central venous catheter (CVC)-associated thrombosis in patients with cancer. Patients and Methods Two hundred fifty-five patients with cancer who required a CVC for at least 7 days were randomly assigned to receive warfarin 1 mg or placebo. Results There were 11 (4.3 %) symptomatic CVC-associated thromboses among 255 patients, with no difference in the incidence of symptomatic CVC-associated thrombosis between patients taking warfarin 1 mg daily (six of 130 patients; 4.6 %) and patients taking placebo (five of 125 patients; 4.0 %; hazard ratio, 1.20; 95 % Cl, 0.37 to 3.94). Warfarin had no effect on CVC life span (84 days v 63 days in control and warfarin groups, respectively; 95 % confidence limit, -16 to 55 days; P = .09), and it did not affect the number of premature CVC removals (23.2 % v 25.4 % in control and warfarin groups, respectively; 95 % confidence limit of difference -8.34 to 12.71; P = .68) or the frequency of major bleeding episodes (2 % v 0 % in control and warfarin groups, respectively; P = .5, Fisher's exact test). Conclusion Symptomatic CVC-associated thrombosis in patients with cancer, although significant, is less common than previously reported. In this study, the administration of warfarin 1 mg daily did not reduce the incidence of symptomatic CVC-associated thrombosis in patients with cancer. However, the low rate of symptomatic CVC-associated thrombosis means that a much larger trial is required to address this issue definitively.
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页码:4063 / 4069
页数:7
相关论文
共 18 条
[1]   VERY LOW-DOSES OF WARFARIN CAN PREVENT THROMBOSIS IN CENTRAL VENOUS CATHETERS - A RANDOMIZED PROSPECTIVE TRIAL [J].
BERN, MM ;
LOKICH, JJ ;
WALLACH, SR ;
BOTHE, A ;
BENOTTI, PN ;
ARKIN, CF ;
GRECO, FA ;
HUBERMAN, M ;
MOORE, C .
ANNALS OF INTERNAL MEDICINE, 1990, 112 (06) :423-428
[2]   Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies [J].
Boraks, P ;
Seale, J ;
Price, J ;
Bass, G ;
Ethell, M ;
Keeling, D ;
Mahendra, P ;
Baglin, T ;
Marcus, R .
BRITISH JOURNAL OF HAEMATOLOGY, 1998, 101 (03) :483-486
[3]   Physician compliance with warfarin prophylaxis for central venous catheters in patients with solid tumors [J].
Carr, KM ;
Rabinowitz, I .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (21) :3665-3667
[4]  
Couban S, 2001, BLOOD, V98, p267A
[5]  
DRAKOS PE, 1992, CANCER-AM CANCER SOC, V70, P1895, DOI 10.1002/1097-0142(19921001)70:7<1895::AID-CNCR2820700715>3.0.CO
[6]  
2-I
[7]   LOCAL INFUSION OF UROKINASE FOR THE LYSIS OF THROMBOSIS ASSOCIATED WITH PERMANENT CENTRAL VENOUS CATHETERS IN CANCER-PATIENTS [J].
FRASCHINI, G ;
JADEJA, J ;
LAWSON, M ;
HOLMES, FA ;
CARRASCO, HC ;
WALLACE, S .
JOURNAL OF CLINICAL ONCOLOGY, 1987, 5 (04) :672-678
[8]  
HAIRE WD, 1991, BONE MARROW TRANSPL, V7, P57
[9]   Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis [J].
Heaton, DC ;
Han, DY ;
Inder, A .
INTERNAL MEDICINE JOURNAL, 2002, 32 (03) :84-88
[10]   THE RISK-FACTORS IN CENTRAL VENOUS CATHETER-RELATED THROMBOSIS [J].
KOKSOY, C ;
KUZU, A ;
ERDEN, I ;
AKKAYA, A .
AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 1995, 65 (11) :796-798