导管相关深静脉血栓:我们的现状和未来?最新进展和尚未满足的临床需求

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Laura Girardi, Marcello Di Nisio, Matteo Candeloro, Emanuele Valeriani, Walter Ageno
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引用次数: 0

摘要

背景导管相关血栓形成(CRT)是影响留置静脉导管患者的主要并发症之一,通常涉及上肢深静脉系统。这种情况可能导致肺栓塞和败血症等危及生命的并发症。发生 CRT 的风险因导管类型和患者特征而异。尽管材料和技术不断进步,但 CRT 的实际发病率仍然相当高。关于 CRT 管理的现有证据仍存在争议,临床指南是根据与导管无关的上肢或下肢深静脉血栓的数据提出建议的。目的 本叙述性综述旨在描述 CRT 的流行病学,回顾关于其管理的现有证据,并强调目前尚未满足的需求。内容CRT的管理需要在血栓进展、复发事件和全身性栓塞的风险与通常情况下脆弱患者增加的出血风险之间取得谨慎的平衡。悬而未决的问题包括导管的最佳管理以及抗凝治疗的类型和持续时间。直接口服抗凝剂的处方越来越多,在选定的病例中,它是标准护理低分子量肝素的重要替代品。在这种情况下,XI 和 XII 因子抑制剂等新型抗凝药物的开发可能会带来更多优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Catheter‐related deep vein thrombosis: Where are we at and where are we going? Updates and ongoing unmet clinical needs
BackgroundCatheter‐related thrombosis (CRT) is one of the major complications affecting patients with indwelling venous catheters, usually involving the upper extremity deep venous system. This condition can lead to potentially life‐threatening complications such as pulmonary embolism and sepsis. The risk of developing CRT varies depending on type of catheters and patient characteristics. Despite advances in materials and technologies, the actual incidence of CRT is still considerable. Available evidence on CRT management remains controversial, and clinical guidelines base their recommendations on data from non‐catheter related upper extremity or lower extremity deep venous thromboses.AimsThis narrative review aims to describe the epidemiology of CRT, to review the available evidence on its management and to highlight the current unmet needs.MethodsNo formal search strategy was applied for the revision of the literature. The main sources of information used were Medline and guidelines from international societies.ContentThe management of CRT requires a careful balance between the risk of thrombus progression, recurrent events, and systemic embolization and the increased bleeding risk in often fragile patients. Open issues include the optimal management of the catheter and the type and duration of anticoagulant therapy. Direct oral anticoagulants are increasingly prescribed, representing an important alternative to the standard of care low molecular weight heparins in selected cases. The development of new anticoagulant drugs such as factors XI and XII inhibitors may offer further advantages in this context.ConclusionsThe management of CRT is still challenging with constant need for updated evidence to support tailored approaches.
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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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