Uso de lavados con heparina frente a lepirudina para prevenir la oclusión por aspiración de dispositivos de acceso venoso central

STUDY OBJECTIVE: To determine whether lepirudin flushes are more effective than heparinized saline in preventing withdrawal occlusion of central venous access devices. DESIGN: Randomized, double-blind clinical trial. SETTING: Research institution-tertiary referral center. PATIENTS: Forty-nine adults undergoing bone marrow transplantation for hematologic malignancies or metastatic solid tumors. INTERVENTION: Twenty-four patients received heparin and 25 received lepirudin flushes. The heparin dose was 3 ml of porcine heparin 100 U/ml (300 U) per catheter lumen at least once/day; the lepirudin dose was 3 ml of lepirudin 100 microg/ml (300 microg) per catheter lumen at least once/day. After 3-4 weeks, all 49 patients received the heparin flushes. MEASUREMENTS AND MAIN RESULTS: Efficacy was assessed by the frequency with which the patients were treated with alteplase instillations for withdrawal occlusion of their central venous access devices during the first 4 months of catheterization. Three (12.5%) patients treated with heparin alone and five (20%) treated initially with lepirudin required alteplase instillations for an estimated relative risk with lepirudin versus heparin of 1.6 (95% confidence interval [CI] 0.40-13.86, p=0.70). CONCLUSION: Lepirudin was not more effective than heparin, which may have been related to the conservative dose of lepirudin administered. However, higher lepirudin doses are likely to incur an unacceptable risk of systemic anticoagulation.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

En un ensayo aleatorizado doble ciego, 49 adultos con trasplante de médula ósea recibieron lavados con lepirudina (3 ml, 100 µg/ml) o heparina (3 ml, 100 U/ml) por luz de catéter. En 4 meses, 3/24 pacientes (12,5 %) con heparina y 5/25 (20 %) con lepirudina precisaron alteplasa (RR 1,6; IC 95 % 0,40–13,86; p = 0,70). Según los autores, la lepirudina no fue más eficaz, quizá por la dosis conservadora; aumentarla supondría probablemente un riesgo inaceptable de anticoagulación sistémica.

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