Abstract Number: PB2383
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Prophylaxis
Background: Nonpediatric cystic fibrosis (CF) patients are frequently hospitalized, often requiring placement of a central-venous catheter (CVC). Enoxaparin is often used for prevention of catheter-thrombosis, but requires daily injections. Direct oral anticoagulants (DOACs) provide a potential alternative that may be better accepted by patients.
Aims: Compare the efficacy, safety, and patient acceptance of enoxaparin or a DOAC in prevention of catheter complications in nonpediatric CF patients.
Methods: This retrospective study included CF patients at our hospital with placement of a CVC and received prophylaxis with either enoxaparin or DOAC between 1/2016 and 6/2019. Patients receiving both types of anticoagulants during the same admission were excluded. Patient demographics, medication use, laboratory values, and outcomes were collected from patient charts. Catheter complications included catheter replacement due to thrombosis or need for fibrinolytic therapy. All descriptive data are shown as mean ± standard deviation. Comparisons of categorical data used Fisher’s exact or Chi Square and continuous data by student t test.
Results: We identified 149 CF patients with a CVC receiving enoxaparin (n=70) or DOAC (n=79) for prophylaxis. Of the patients who got enoxaparin, 81% got 40mg daily, and 91% of DOAC use was rivaroxaban 10mg daily. Patient demographics were similar between the groups (Table). Patients receiving a DOAC had a smaller CVC lumen diameter and had more prior catheters compared to enoxaparin patients. More patients receiving enoxaparin refused their doses compared to DOACs (59% vs. 10%; p< 0.001), as well as having more refused doses per patient (6.7±4.8 vs. 1.4±1.1; p=0.003). There were more CVC complications in patients receiving enoxaparin vs. DOACs (17% vs. 6%; p=0.043). No patients experienced major bleeding.
Conclusions: DOACs were better accepted by the patients compared to enoxaparin. DOACs also provided a reduction in catheter complications without increasing the risk of bleeding, making DOACS a promising alternative for CF patients.
| Variable | Enoxaparin (n=70) | DOAC (n=79) | p-value |
| Age (years) | 31.3 ± 10.5 | 30.2 ± 9.0 | 0.454 |
| Female | 53% | 39% | 0.133 |
| BMI | 21.2 ± 4.0 | 20.7 ± 3.8 | 0.436 |
| Length of stay | 10.4 ± 6.0 | 10.9 ± 5.6 | 0.600 |
| Arterial thrombosis risk factors | 0.94 ± 0.99 | 0.63 ± 0.79 | 0.035 |
| Venous thrombosis risk factors | 1.2 ± 1.0 | 1.3 ± 0.8 | 0.477 |
| PICC line | 86% | 92% | 0.293 |
| Catheter lumen size (cm) | 5.6±1.1 | 4.9±0.3 | 0.010 |
| Prior catheters | 5.7±7.0 | 10.9±8.3 | <0.001 |
[Patient and catheter characteristics]
To cite this abstract in AMA style:
Dobesh PP, Brink HL, Huntrods ML, Cui J, Sealer SM. Prevention of Catheter Complications in Patients with Cystic Fibrosis: Enoxaparin vs. a Direct Oral Anticoagulant [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/prevention-of-catheter-complications-in-patients-with-cystic-fibrosis-enoxaparin-vs-a-direct-oral-anticoagulant/. Accessed September 22, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prevention-of-catheter-complications-in-patients-with-cystic-fibrosis-enoxaparin-vs-a-direct-oral-anticoagulant/