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J Vasc Surg. 2018 Nov;68(5):1491-1498. doi: 10.1016/j.jvs.2018.02.039. Epub 2018 May 24.

Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients.

Author information

1
Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China.
2
Department of Radiology, West China Hospital, Sichuan University, Sichuan, China.
3
Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Sichuan, China; Department of Vascular Surgery, West China Hospital, Sichuan University, Sichuan, China.
4
Department of Statistics and Probability, Michigan State University, East Lansing, Mich.
5
Department of Biostatistics, University of Michigan, Ann Arbor, Mich.
6
Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China. Electronic address: tianleicui@163.com.

Abstract

OBJECTIVES:

Catheter-related right atrial thrombosis (CRAT) is an underreported but potentially life-threatening complication associated with the use of tunneled-cuffed catheters among hemodialysis (HD) patients. Because little is known about the evidence-based guidelines for the optimal management of CRAT among HD patients, this article reports findings based on 20 patients diagnosed with CRAT after catheter replacement and anticoagulation treatment.

METHODS:

The article retrospectively reviews the hospital records of 20 HD patients treated in the West China Hospital with diagnosis of CRAT from March 2013 to May 2016. Once CRAT was diagnosed, tunneled-cuffed catheters were exchanged over a guidewire in situ and the locations of the new catheter tips were adjusted to be away from the original sites. Immediately after the insertion of a new tunneled-cuffed catheter and at the end of each HD session, both ports of the catheters were locked with unfractionated heparin solution. Patients younger than 70 years of age were treated with warfarin at a target International Normalized Ratio of 1.5 to 1.9, whereas those older than 70 years were treated with dual antiplatelet therapy. All patients were on regular dialysis without thrombolysis or thrombectomy.

RESULTS:

During the follow-up, two patients died of gastrointestinal massive hemorrhage and one died of acute myocardial infarction. No fatal pulmonary embolism or other CRAT complication-related deaths were observed. A total of eight patients had complete dissolution of CRAT, and 12 patients had reduction in thrombi size.

CONCLUSIONS:

Maintenance of HD by replacing catheters and providing oral anticoagulation/antiplatelet therapies may be an effective strategy for treating HD patients with CRAT.

KEYWORDS:

Anticoagulants; Catheter; Hemodialysis; Management; Thrombosis

PMID:
29804743
DOI:
10.1016/j.jvs.2018.02.039
[Indexed for MEDLINE]
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