C Lersch1, W Kotowa, S Fung, D Janssen. 1. II. Medizinische Klinik der Technischen Universität München, Klinikum Rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany. christian.lersch@lrz.tu-muenchen.de
Abstract
PURPOSE: Thromboses occur in connection with the use of venous port systems. Valid data on the instillation of heparin-based solutions in the lumen of the port system are lacking. METHODS: One hundred and seventy-three patients with malignancy from 19 centres who had participated in an observation study of subcutaneous thromboprophylaxis with dalteparin-Na (Fragmin P/-Forte) were analysed with a view to flushing the port systems and investigating any related influence on the occurrence of catheter-associated thromboses. RESULTS: All catheter-associated thromboses were seen in centres which used either no UFH, or UFH concentrations of up to 250 IU/ml (8/108; 7.4%). The rate of thrombosis rose to 10% (6/60) if no high-risk dose of dalteparin was applied subcutaneously. On the other hand, the rate of catheter-associated thromboses under the high-risk dose of dalteparin and/or a more highly concentrated instillation fluid, at 0.9% (1/113), was much lower. One haemorrhage from gastric ulcer occurred under the highest UFH concentration in the instillation fluid (2,500 IU UFH/ml). CONCLUSION: The results indicate that a concentration between 500 IU UFH/ml and 1,000 IU UFH/ml in the instillation solution, at the same time as high-risk prophylaxis with subcutaneous dalteparin for prevention of catheter-associated thromboses, is effective in patients with manifest tumour disease. The instillation of LMWH-based solutions at a concentration of approx 500 anti-Xa units/ml should be discussed as a pending issue.
PURPOSE: Thromboses occur in connection with the use of venous port systems. Valid data on the instillation of heparin-based solutions in the lumen of the port system are lacking. METHODS: One hundred and seventy-three patients with malignancy from 19 centres who had participated in an observation study of subcutaneous thromboprophylaxis with dalteparin-Na (Fragmin P/-Forte) were analysed with a view to flushing the port systems and investigating any related influence on the occurrence of catheter-associated thromboses. RESULTS: All catheter-associated thromboses were seen in centres which used either no UFH, or UFH concentrations of up to 250 IU/ml (8/108; 7.4%). The rate of thrombosis rose to 10% (6/60) if no high-risk dose of dalteparin was applied subcutaneously. On the other hand, the rate of catheter-associated thromboses under the high-risk dose of dalteparin and/or a more highly concentrated instillation fluid, at 0.9% (1/113), was much lower. One haemorrhage from gastric ulcer occurred under the highest UFH concentration in the instillation fluid (2,500 IU UFH/ml). CONCLUSION: The results indicate that a concentration between 500 IU UFH/ml and 1,000 IU UFH/ml in the instillation solution, at the same time as high-risk prophylaxis with subcutaneous dalteparin for prevention of catheter-associated thromboses, is effective in patients with manifest tumour disease. The instillation of LMWH-based solutions at a concentration of approx 500 anti-Xa units/ml should be discussed as a pending issue.
Authors: R Delva; E Gamelin; A Lortholary; P Maillart; P Leynia de la Jarrige; C Girault; J Guérin; F Larra Journal: Support Care Cancer Date: 1998-07 Impact factor: 3.603
Authors: M Schenck; W Michels-Oswald; S Tschirdewahn; H Rübben; F Vom Dorp; A Rose; A Panic; C Niedworok; R Rossi Journal: Urologe A Date: 2012-02 Impact factor: 0.639