Abstract
PURPOSE: To retrospectively evaluate the safety and efficacy of direct oral anticoagulant therapy for fibrin sheath-induced central venous port system dysfunction. MATERIAL AND METHODS: Between May 2023 and February 2024, patients who underwent direct oral anticoagulant therapy for fibrin sheath-induced central venous port system dysfunction were included. The clinical effectiveness, flow confirmation study, central venous port function, and adverse events according to the Common Terminology Criteria for Adverse Events classification were retrospectively reviewed. RESULTS: Nine patients were included in the study. The catheter types were open-ended (n = 8) and Groshong (n = 1). All patients had difficulty with aspiration, and one exhibited injection resistance. All patients received edoxaban as direct oral anticoagulant, at doses of 30 mg (n = 3) or 60 mg (n = 6) based on their body weights. After direct oral anticoagulant administration, complete fibrin sheath resolution was confirmed by a flow confirmation study in all cases, with a mean duration of 29 ± 21 days. Concurrently, the central venous port system dysfunction was restored in eight cases. In the remaining one case, direct oral anticoagulant administration was suspended on day 26 due to grade 1 epistaxis; therefore, central venous port system dysfunction remained despite the disappearance of the fibrin sheath. Thus, the clinical success rate was 88.9% (8/9) and fibrin sheath disappearance rate was 100% (9/9), respectively. No grade 3 or higher adverse effect was observed. No recurrence of fibrin sheath-induced central venous port system dysfunction was observed during the mean follow-up period of 133 ± 98 days. CONCLUSIONS: Direct oral anticoagulant administration can be a potentially effective and safe strategy for managing fibrin sheath-induced central venous port system dysfunction formation.