Prophylaxis of port system-associated thromboses in advanced oncology patients using heparin flushing.
OBJECTIVE
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).


CONCLUSIONS
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.
Lersch
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C
II. Medizinische Klinik der Technischen Universität München, Klinikum Rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany. christian.lersch@lrz.tu-muenchen.de
Kotowa
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W
Fung
S
S
Janssen
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D017985:Dalteparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D000970:Antineoplastic Agents; D017985:Dalteparin