Download PDF
Thromb Haemost 1997; 77(01): 048-052
DOI: 10.1055/s-0038-1655905
Clinical Studies
Schattauer GmbH Stuttgart

Thrombin Activity Associated with Indwelling Central Venous Catheters

Charles W Francis
The Hematology Unit, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
,
Andrew H Felcher
The Hematology Unit, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
,
Janice White
The Hematology Unit, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
,
Julie V Braaten
The Hematology Unit, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
,
Rachel Goss
The Hematology Unit, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
› Author Affiliations
Further Information

Publication History

Received 05 March 1996

Accepted after resubmisssion 11 September 1996

Publication Date:
11 July 2018 (online)

  PDF Download  Permissions and Reprints

Summary

Thrombotic complications are frequent with indwelling central venous catheters and result in catheter dysfunction, vascular obstruction and may also contribute to catheter-associated infections. The pathogenesis of catheter thrombosis is not well characterized but may involve vessel damage, local stasis and catheter-associated thrombin formation. We have, therefore, measured the thrombin activity associated with central venous catheters removed from patients and have also determined the ability of hirudin to inactivate catheter-associated thrombin. We obtained 48 catheters from 46 patients and removed 1 cm portions for study. These were taken from the distal end, 5 cm proximal, and 15 cm proximal from the end. Following washing, thrombin activity was measured with a chromogenic assay. Thrombin was associated with 40 of 48 catheters and with 100 of 144 segments with a mean activity of 132 ± 27 μU/cm with a range of 0 to 2,160 μU/cm. Incubation in hirudin reduced the activity from a mean of 122 ± 33 μU/cm to 18 ± 6 μU/cm (p <.001). Scanning electron microscopy of selected catheters showed that some had areas of fibrin deposition which was not apparent visually. The findings indicate that indwelling central venous catheters frequently have associated thrombin activity which can be inhibited by a direct-acting thrombin inhibitor such as hirudin.

 

  • References

  • 1 Abraham JL, Mullen JL. A prospective study of prolonged central venous access in leukemia. JAMA 1982; 248: 2868-2873
    CrossrefPubMedGoogle Scholar
  • 2 Anderson AJ, Krasnow SH, Boyer MW, Cutler DJ, Jones BD, Citron ML, Ortega LG, Cohen MH. Thrombosis: the major Hickman catheter complication in patiens with solid tumor. Chest 1989; 95: 71-75
    CrossrefPubMedGoogle Scholar
  • 3 Lokich JJ, Becker B. Subclavian vein thrombosis in patients treated with infusion chemotherapy for advanced malignancy. Cancer 1983; 52: 1585-1589
    PubMedGoogle Scholar
  • 4 Gould JR, Carloss HW, Skinner WL. Groshong catheter-associated subclavian venous thrombosis. Am J Med 1993; 95: 419-423
    CrossrefPubMedGoogle Scholar
  • 5 Eastridge BJ, Lefor AT. Complications of indwelling venous devices in cancer patients. J Clin Oncol 1995; 13: 233-238
    CrossrefPubMedGoogle Scholar
  • 6 Chastre J, Cornud F, Bouchama A, Viau F, Benacerraf R, Gibert C. Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein. N Engl J Med 1982; 306: 278-280
    CrossrefPubMedGoogle Scholar
  • 7 Haire WD, Lynch TG, Lieberman RP, Lund GB, Edney JA. Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis. J Ultrasound Med 1991; 10: 493-496
    CrossrefPubMedGoogle Scholar
  • 8 Passerini L, Lam K, Costerton JW, King EG. Biofilms on indwelling vascular catheters. Crit Care Med 1992; 20: 665-673
    CrossrefPubMedGoogle Scholar
  • 9 Bambauer R, Mestres P, Pirrung KJ, Sioshansi P. Scanning electron microscopic investigation of catheters for blood access. Artif Organs 1994; 18: 272-275
    CrossrefPubMedGoogle Scholar
  • 10 Hombrouckx R, D’Halluin F, Bogaert AM, Leroy F, DeVos JY, Larno L. Fibrin sheet covering subclavian or femoral dialysis catheters. Artif Organs 1994; 18: 322-324
    CrossrefPubMedGoogle Scholar
  • 11 Press OW, Ramsey PG, Larson EB, Fefer A, Hickman RO. Hickman catheter infections in patients with malignancies. Medicine 1984; 63: 189-200
    CrossrefPubMedGoogle Scholar
  • 12 Harms D, Görtitz I, Lambrecht W, Kabisch H, Erttmann R, Janka-Schaub G. Infectious risks of Broviac catheters in children with neoplastic diseases: a matched pairs analysis. Pediatr Infect Dis J 1992; 11: 1014-1018
    CrossrefPubMedGoogle Scholar
  • 13 Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, Armstrong D. Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Int Med 1993; 119: 1168-1174
    CrossrefPubMedGoogle Scholar
  • 14 Garrison RN, Wilson MA. Intravenous and central catheter infections. Surg Clinics No Am 1994; 74: 557-570
    PubMedGoogle Scholar
  • 15 Gosbell IB, Duggan D, Breust M, Mulholland K, Gottlieb T, Bradbury R. Infection associated with central venous catheters: a prospective study. Med JAust 1995; 162: 210-213
    PubMedGoogle Scholar
  • 16 Ascher DP, Shoupe BA, Maybee D, Fischer GW. Persistent catheter-related bacteremia: Clearance with antibiotics and urokinase. J Ped Surg 1993; 28: 627-929
    CrossrefPubMedGoogle Scholar
  • 17 Raad II, Luna M, Khalil S-AM, Lam C, Bodey GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994; 271: 1014-1016
    CrossrefPubMedGoogle Scholar
  • 18 Efsing HO, Lindblad B, Mark J, Wolff T. Thromboembolic complications from central venous catheters: A comparison of three catheter materials. World J Surg 1983; 07: 419-423
    CrossrefPubMedGoogle Scholar
  • 19 Costanzo JD, Sastre B, Choux R, Reynier JP, Noirclerc M, Cano N, Martin J. Experimental approach to prevention of catheter-related central venous thrombosis. J Parenteral and Enteral Nutrition 1984; 08: 293-297
    PubMedGoogle Scholar
  • 20 Bern MM, Lokich JJ, Wallach SR, Bothe A, Benotti TN, Arkin CF, Greco FA, Huberman M, Moore C. Very low doses of warfarin can prevent thrombosis in central venous catheters. Ann Int Med 1990; 112: 423-428
    CrossrefPubMedGoogle Scholar
  • 21 Smith S, Dawson S, Hennessey R, Andrew M. Maintenance of the patency of indwelling central venous catheters: Is heparin necessary?. Am J Ped Hematol/Oncol 1991; 13: 141-143
    PubMedGoogle Scholar
  • 22 Francis CW, Markham RE Jr, Barlow GH, Florack TM, Dobrzynski DM, and Marder VJ. Thrombin activity of fibrin thrombi and soluble plasmic derivatives. J Lab Clin Med 1983; 102: 220-230
    PubMedGoogle Scholar
  • 23 Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors. J Clin Invest 1990; 85: 385-391
    CrossrefPubMedGoogle Scholar
  • 24 Rubens FD, Weitz JI, Brash JL, Kinlough-Rathbone RL. The effect of antithrombin Ill-independent thrombin inhibitors and heparin on fibrin accretion onto fibrin-coated polyethylene. Thromb Haemost 1993; 69: 130-134
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Prager NA, Abendschein DR, McKenzie CR, Eisenberg PR. Role of thrombin compared with factor Xa in the procoagulant activity of whole blood clots. Circulation 1995; 92: 962-967
    CrossrefPubMedGoogle Scholar
  • 26 Wagner WR, Johnson PC, Heil BV, Thompson KA, Kormos RL, Griffith BP. Thrombin activity resides on LBAD dacron inflow and outflow grafts. ASAIO Journal 1992; 38: M634-M637
    CrossrefPubMedGoogle Scholar
  • 27 Hoar PF, Wilson RM, Mangano DT, Avery II GJ, Szamicki RJ, Hill JD. Heparin bonding reduces thrombogenicity of pulmonary-artery catheters. N Engl J Med 1981; 305: 993-995
    CrossrefPubMedGoogle Scholar
  • 28 Elgue G, Blombäck M, Olsson P, Riesenfeld J. On the mechanism of coagulation inhibition on surfaces with end point immobilized heparin. Thromb Haemost 1993; 70: 289-293
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Krafte-Jacobs B, Sivit CJ, Mejia R, Pollack MM. Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Ped 1995; 126: 50-54
    CrossrefPubMedGoogle Scholar
  • 30 Hogg PJ, Jackson CM. Fibrin monomer protects thrombin from inactivation by heparin-ATIII: Implication for heparin efficacy. Proc Natl Acad Sci 1989; 86: 3619-3623
    CrossrefPubMedGoogle Scholar
  • 31 Gast A, Tschopp TB, Schmid G, Hilpert K, Ackermann J. Inhibition of clot-bound and free (fluid-phase thrombin) by a novel synthetic thrombin inhibitor (Ro 46-6240), recombinant hirudin and heparin in human plasma. Blood Coag Fibrinol 1994; 05: 879-887
    CrossrefPubMedGoogle Scholar
  • 32 Berry CN, Girardot C, Lecoffre C, Lunven C. Effects of the synthetic thrombin inhibitor argatroban on fibrin- or clot-incorporated thrombin: Comparison with heparin and recombinant hirudin. Thromb Haemost 1994; 72: 281-286
    Article in Thieme ConnectPubMedGoogle Scholar