Catheter associated thromboses in patients with sickle cell anaemia and dual lumen Vortex apheresis ports are common and can be clinically asymptomatic

Abstract

Sickle cell anaemia (SCA) is a recognised prothrombotic condition. 1 The incidence rate for first venous thromboembolism (VTE) is reported at 5.2 events/1000 person years with a cumulative incidence of 11.3% by age 40 years. 2,3 This is fifty times higher than the quoted VTE risk for under 40 year olds. 4 Long-term exchange blood transfusion (EBT) is an important therapeutic option, however, use of an indwelling venous access device (IVAD) may be necessary to maintain venous access. The attendant risk of catheter related thrombosis (CRT) is influenced by patient, disease and catheter characteristics. 5 Previous reports regarding CRT and IVADs in the SCA population, listed in Table I, often grouped external and internal, and single and dual lumen devices together, making analysis challenging. The per-person thrombotic rate in adults ranges from 19-41%, 6-10 whilst in children this rate is 0-10%. [10][11][12] One study reported no significant difference in CRT rates between dual (23%) or single (33%) lumen devices, 10 whilst another reported increased rates with dual lumen devices in their pediatric population (25% vs. 0%), although these patients were also older and having automated erythrocytopheresis as opposed to manual exchange. 13 By comparison, in the cancer population the rate is only 3-4%. 5 Thus, adults with SCA are a high risk group for CRT.We performed a five year retrospective analysis of IVADs

Use of infusion ports in patients with sickle cell disease: Indications and complications

“…33 Right atrial thrombus has also been detected, which may be related to catheter tip position in the right atrium. 34 Despite the risks of thrombosis from SCD and CVADs, we observed a low rate of thrombosis of 0.03 per 1000 catheter days, which is consistent with findings in a similar cohort of pediatric patients with SCD. 4,8,9 Ordonez et al also reported a similarly low rate of thrombosis of 0.07 per 1000 catheter days among pediatric patients with SCD and TM.…”

“…also reported that catheters were a significant trigger for venous thrombosis, and thrombosis was more likely to occur in patients with sickle cell anemia genotypes 33 . Right atrial thrombus has also been detected, which may be related to catheter tip position in the right atrium 34 . Despite the risks of thrombosis from SCD and CVADs, we observed a low rate of thrombosis of 0.03 per 1000 catheter days, which is consistent with findings in a similar cohort of pediatric patients with SCD 4,8,9 .…”

Thromboprophylaxis Reduced Venous Thromboembolism in Sickle Cell Patients with Central Venous Access Devices: A Retrospective Cohort Study

“…All atrial thrombi were diagnosed in patients with Vortex ® and Xcela Power ® CVAD. Similarly, Brewin and colleagues observed asymptomatic atrial thrombi in 10% of patients with Vortex LP ® [ 8 ]. Atrial thrombi are an under-recognized and potentially fatal consequences of CVAD, with an estimated prevalence of up to 18% in patients on hemodialysis [ 23 , 24 , 25 ].…”

“…SCD patients often require central venous access devices (CVADs) for chronic transfusions and/or iron chelation. Unfortunately, CVADs are known to be highly prothrombotic with a catheter-related thrombotic rate of 24% in SCD patients [ 8 ].…”

Near-Infrared Spectroscopy Demonstrates the Benefit of Erythracytapheresis in Sickle Cell Disease Adult Patients with Cerebral Vasculopathy

“…Moreover, BET was unable to prevent stroke in SS patients [ 6 , 7 , 8 ]. On the other hand, transfusions are associated with complications including delayed hemolysis transfusion reactions [ 9 , 10 ], infections and thrombosis on catheters [ 11 ] or arterio-veinous fistula [ 12 ], and represent a burden on blood delivery. It is therefore necessary to provide evidence of a beneficial effect of BET in adults with cerebral vasculopathy.…”