A model to assess the risk of peripherally inserted central venous catheter-related thrombosis in patients with breast cancer: a retrospective cohort study

Abstract

Purpose: Limited risk assessment tool to stratify the risk of PICC-related thrombosis (PICC-RVT) in breast cancer patients. This study developed a model to assess the risk of PICC-RVT in breast cancer patients.Methods: We conducted a retrospective cohort study of 1284 breast cancer patients receiving PICC insertion during 1 January 2015 -31 August 2019 at a cancer specialized hospital in Hunan province, China. The entire population is divided into two groups at a ratio of 3:1 which included a derivation sample (n=978), and a validation sample (n=284). PICC-RVT was con rmed by ultrasonography in the presence of clinical symptoms and signs.Results: PICC-RVT occurred in 40 (4.09%) of the derivation sample patients. Multivariable analysis identi ed 9 variables: chronic obstructive pulmonary disease, prior central venous catheter placement, higher level of Platelets, higher level of D-dimer, lower level of Activated partial thromboplastin time, menopause, no prior breast surgery, upper extremity lymphedema, and endocrine therapy. Points were assigned to each variable according to regression coe cient. The model had an area under the receiver operating characteristics curve (AUC) of 0.850 (95% CI 0.776 to 0.924), The Hosmer-Lemeshow goodness of t was 4.781 (p=0.572). At a cutoff value of 3.5, the sensitivity and specifcity were 75% and 83%, respectively.Conclusion: Several disease-speci c factors of breast cancer (e.g., menopause, endocrine therapy and upper extremity lymphedema) play important roles in the development of PICC-RVT. Patients at higher PICC-RVT risk could be candidates for close post-insertion monitoring and interventions to prevent PICC-RVT.

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

“…Two studies by Albertin et al and Peng et al reported an OR for thrombosis per one-unit increase in platelet count of 1.004 (95% CI: 1.001–1.008) and 3.783 (95% CI: 1.756–8.149), respectively. 29 66 Quan et al reported an OR = 1.009 (95% CI: 1.002–1.015) for ischemic stroke with higher platelet count, but did not state a definition of higher platelet count. 69…”

“…The patents received thromboprophylaxis in 10 studies, 30 33 41 50 67 78 87 106 119 121 some patients received thromboprophylaxis in 19 studies, 3 44 59 61 66 73 81 85 86 90 91 92 99 101 104 108 111 113 115 and no thromboprophylaxis was used in 25 studies. 14 35 36 38 39 40 42 43 46 47 51 52 56 70 74 75 77 83 87 Thromboprophylaxis was not reported in 46 studies.…”

“…Seventeen studies rating good or fair found an association between higher platelet count and thrombosis with a risk estimate. 7 14 29 46 57 58 59 60 66 69 72 74 77 84 85 112 122 Sixteen of these had VTE as outcome, 7 14 29 46 57 58 59 60 66 72 74 77 84 85 112 122 and one had ischemic stroke as outcome. 69…”

“…Two studies by Albertin et al and Peng et al reported an OR for thrombosis per one-unit increase in platelet count of 1.004 (95% CI: 1.001-1.008) and 3.783 (95% CI: 1.756-8.149), respectively. 29,66 Quan et al reported an OR ¼ 1.009 (95% CI: 1.002-1.015) for ischemic stroke with higher platelet count, but did not state a definition of higher platelet count. 69 Five studies rating poor 28,32,33,63,78 also indicated an association between higher platelet count and thrombosis, while Kenmotsu et al indicated a higher risk of VTE with platelet count 350 Â 10 9 /L.…”

“…Seventeen studies rating good or fair found an association between higher platelet count and thrombosis with a risk estimate. 7,14,29,46,[57][58][59][60]66,69,72,74,77,84,85,112,122 Sixteen of these had VTE as outcome, 7,14,29,46,[57][58][59][60]66,72,74,77,84,85,112,122 and one had ischemic stroke as outcome. 69 Seven of the studies investigated OR for thrombosis with higher platelet count and found ORs varying from 1.41 (95% CI: 1.03-1.92) to 3.99 (95% CI: 1.09-14.7).…”