Table I.
Overview of the international guidelines on the prevention and treatment of catheter-related thrombosis.
| PN guidelines | Primary CRT prevention | Treatment of CRT and prevention of recurrent CRT | |
|---|---|---|---|
| DGEM (2009)6 | Low-dose oral prophylactic anticoagulant during long-term PN (grade B) | Urokinase/tPA | - |
| ESPEN (2009)7 | Once-daily LMWH 100 IU/kg in high-risk patients on long-term PNa (grade C) | Removal of the catheter if infected, malpositioned or obstructed (grade B); local/systemic urokinase/tPA for acute symptomatic CRT within 24 h from symptom onset (grade C) | Long-term LMWH or LMWH followed by VKA for subacute symptomatic CRT (grade C); LMWH are preferred (grade C) |
| AuSPEN (2008)5 | - | Low-dose tPA within 3–4 days of symptom onset. Stenting of the partially occluded superior vena cava to enable reinsertion of a CVC (consensus) | In case of CRT resolution, the catheter can remain in place and anticoagulation therapy considered. Long-term warfarin is preferred (consensus) |
| SINPE (2002)9 | Low-dose VKA or LMWH during long-term PNb (grade C) | - | - |
| ASPEN (2002)3 | Low-dose anticoagulant during long-term PNb (grade B) | - | - |
| Other guidelines | Primary CRT prevention | Treatment of CRT and prevention of recurrent CRT | |
| ISTH (2014)10 | No routine CRT prophylaxis/heparin flushes (adult cancer patients) | Anticoagulation with LMWH and no catheter removal in cancer patients; removal if infected or malpositioned; anticoagulation for incidental CRT; anticoagulation over thrombolysis (adult cancer patients) | 3–6 months of anticoagulation; LMWH over warfarin; long-term anticoagulation in patients with persistent need of central venous access (adult cancer patients) |
| ACCP (2012)11 | No routine CRT prophylaxis (grade 2C) | No catheter removal if it is functional (grade 2C); if proximal veins are involved, anticoagulation for 3 months (adults; grade 2C) | After catheter removal, anticoagulation for 3 months (adults; grade 2C); if no catheter removal, long-term anticoagulation (adults; grade 1C) |
| ACCP (2012)47,50 | UFH infusion at 0.5 IU/kg for catheter patency over no prophylaxis in neonates (grade 1A) | Catheter removal; either anticoagulation or radiological monitoring; LMWH or UFH followed-by LMWH for 6 weeks-3 months (neonates and children; grade 2C) | If catheter is still in place on completion of therapeutic anticoagulation, prophylactic anticoagulation until catheter is removed (neonates and children; grade 2C) |
| GCPG (2013)13 | No routine CRT prophylaxis in cancer patients | Anticoagulation for 3 months, no catheter removal if it is functional, LMWH preferred (adult cancer patients) | No recommendations on the duration of anticoagulation (adult cancer patients) |
Patients with cancer, chronic inflammatory disease, or family/personal history of idiopathic venous thrombosis.
Long-term PN, no contraindication to receive anticoagulants.
PN: parenteral nutrition; DGEM: Deutsche Gesellschaft für Ernährungsmedizin (German Society for Clinical Nutrition); CRT: catheter-related thrombosis; tPA: tissue plasminogen activator; ESPEN: European Society for Clinical Nutrition and Metabolism; LMWH: low-molecular weight heparin; VKA: vitamin K antagonist; AuSPEN: Australasian Society for Parenteral and Enteral Nutrition; CVC: central venous catheter; SINPE: Società Italiana di Nutrizione Artificiale e Metabolismo (Italian Society of Artificial Nutrition and Metabolism); ASPEN: American Society for Parenteral and Enteral Nutrition; ISTH: International Society on Thrombosis and Haemostasis; ACCP: American College of Chest Physicians; UFH: unfractionated heparin; GCPG: Good Clinical Practices Guidelines; IU: international units.