Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis

Heaton, D. C.; Han, Dongdong; Inder, Alison

doi:10.1046/j.1445-5994.2002.d01-28.x

Cited by 81 publications

(94 citation statements)

References 15 publications

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“…Using the specified selection criteria, a total of nine prospective studies of thromboprophylaxis use in adult cancer patients with CVC were identified (Table 1) (Bozzetti et al, 1983;Bern et al, 1990;Monreal et al, 1996;Nightingale et al, 1997;Boraks et al, 1998;Heaton et al, 2002;Mismetti et al, 2003;Couban et al, 2005;Verso et al, 2005). Of these studies, one investigated unfractionated heparin thromboprophylaxis, (Bozzetti et al, 1983) while another three studied the efficacy of different low molecular weight heparin preparations (dalteparin, nadroparin and enoxaparin, respectively) (Monreal et al, 1996;Mismetti et al, 2003;Verso et al, 2005).…”

Section: Resultsmentioning

confidence: 99%

“…Of these studies, one investigated unfractionated heparin thromboprophylaxis, (Bozzetti et al, 1983) while another three studied the efficacy of different low molecular weight heparin preparations (dalteparin, nadroparin and enoxaparin, respectively) (Monreal et al, 1996;Mismetti et al, 2003;Verso et al, 2005). Use of minidose warfarin (1 mg daily) was studied in six independent trials, incorporating 1463 patients (Bern et al, 1990;Nightingale et al, 1997;Boraks et al, 1998;Heaton et al, 2002;Mismetti et al, 2003;Couban et al, 2005).…”

Section: Resultsmentioning

confidence: 99%

“…In total, only nine prospective studies investigating the role of thromboprophylaxis in adult patients with cancer have been identified, and only within the last year have the first double-blind, randomised-controlled studies been published. Moreover, six of these nine studies enrolled fewer than 125 cancer patients in total (Bozzetti et al, 1983;Bern et al, 1990;Monreal et al, 1996;Boraks et al, 1998;Heaton et al, 2002;Mismetti et al, 2003). In view of the small numbers of patients in these studies, it is not perhaps surprising that they reached conflicting conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…Heaton et al (2002) investigated 88 adult patients with haematological malignancies who required insertion of either a double lumen Hickman line (n ¼ 78) or double lumen Groshong catheter (n ¼ 10). A total of 45 patients were randomised to receive warfarin 1 mg daily started on the day of insertion and continued for a further 90 days or until development of clinical thrombosis.…”

Section: Warfarin Thromboprophylaxis In Cancer Patients With Cvcmentioning

confidence: 99%

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Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

et al. 2006

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Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Warfarin Thromboprophylaxis In Cancer Patients With Cvcmentioning

confidence: 99%

See 2 more Smart Citations

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

et al. 2006

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“…Although some early open-label trials suggested a benefit from oral, low-dose daily warfarin 83 or daily SC dose of LMWH, 84 more recent double-blind, placebo-controlled RCTs did not find any advantages for either of these prevention strategies. [85][86][87] The choice to start prophylaxis against venous thromboembolic events in all oncology patients bearing a CVC, either with LMWH or with minidose warfarin, remains unsupported by evidence-based medicine.…”

Section: Thrombosismentioning

confidence: 99%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

257

166

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Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

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Anticoagulation for people with cancer and central venous catheters

Kahale

Tsolakian

Hakoum

et al. 2018

Cochrane Database of Systematic Reviews

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The evidence was not conclusive for the effect of LMWH on mortality, the effect of VKA on mortality and catheter-related VTE, and the effect of LMWH compared to VKA on mortality and catheter-related VTE. We found moderate-certainty evidence that LMWH reduces catheter-related VTE compared to no LMWH. People with cancer with CVCs considering anticoagulation should balance the possible benefit of reduced thromboembolic complications with the possible harms and burden of anticoagulants.

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Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis

Abstract: This study found no benefit of the routine use of minidose warfarin for prophylaxis of central vein' catheter thrombosis in patients with haematological malignancies and therefore does not support the routine use of minidose warfarin for prophylaxis in such patients.

Cited by 81 publications

References 15 publications

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Vascular Access in Oncology Patients

Anticoagulation for people with cancer and central venous catheters

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