Anticoagulants for the prevention and treatment of catheter-related thrombosis in adults and children on parenteral nutrition: a systematic review and critical appraisal

• Published in: Blood transfusion = Trasfusione del sangue Vol. 15; no. 4; pp. 369 - 377
• Main Authors: Barco, Stefano, Atema, Jasper J, Coppens, Michiel, Serlie, Mireille J, Middeldorp, Saskia
• Format: Journal Article
• Language: English
• Published: Italy Edizioni SIMTI - SIMTI Servizi Srl 01-07-2017
• Subjects: Adolescent; Adult; Anticoagulants - therapeutic use; Catheters - adverse effects; Child; Child, Preschool; Female; Humans; Infant; Male; Observational Studies as Topic; Parenteral Nutrition - adverse effects; Review; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors
• ISSN: 1723-2007
• DOI: 10.2450/2016.0031-16

Patients on parenteral nutrition require a central venous access and are at risk of catheter-related thrombosis, pulmonary embolism, and vena cava syndrome. Parenteral nutrition guidelines suggest anticoagulation for the primary prevention of catheter-related thrombosis during long-term parenteral nutrition. We conducted a systematic review of the efficacy, safety and feasibility of anticoagulant use for preventing and treating catheter-related thrombosis during parenteral nutrition.
We searched for interventional and observational studies on adults and children receiving systemic anticoagulants during either short- or long-term parenteral nutrition delivered via central venous access. Primary outcomes were: objectively-confirmed catheter-related thrombosis, pulmonary embolism and bleeding. Secondary outcomes were: heparin-induced thrombocytopenia, prevalence of anticoagulation, and quality of International Normalised Ratio management in vitamin K antagonist-treated patients.
We identified 1,199 studies, of which 23 were included. Seven interventional studies of short-term parenteral nutrition (adult population, n=5) were classified as low-quality: in those, intravenous unfractionated heparin did not prevent catheter-related thrombosis if compared to saline. No interventional studies were conducted in patients on long-term parenteral nutrition. Observational data were sparse, rarely focusing on anticoagulation, and overall of low quality. The reported use of anticoagulants was between 22 and 66% in recent multicentre cohorts.
The amount and quality of data in this area are very suboptimal: most studies are outdated and involved heterogeneous populations. Currently, there is insufficient evidence to allow conclusions to be reached regarding the efficacy and safety of anticoagulants in this setting.