Clinical relevance of genetic risk factors for thrombosis in paediatric oncology patients with central venous catheters

Wermes, C.; Prondzinski, M. von Depka; Lichtinghagen, Ralph; Barthels, Monika; Welte, Karl; Sykora, Karl‐Walter

doi:10.1007/pl00014341

Cited by 95 publications

(94 citation statements)

References 12 publications

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“…In agreement with these findings, Riordan and colleagues [19] found a low prevalence of factor V Leiden gene mutation in 28 cancer patients with catheter-related venous thrombosis. In contrast, other groups did find an association between factor V Leiden and prothrombin gene mutations and thrombosis in paediatric [20] and in adult patients with haematological malignancies [21]. One explanation could be that gene mutations only carry a low additional risk that does not have a substantial impact on thrombosis incidence when other factors already result in a high incidence of venous thrombosis.…”

Section: Discussionmentioning

confidence: 87%

Risk factors for catheter-related thrombosis in cancer patients

Tesselaar¹,

Ouwerkerk²,

Nooy³

et al. 2004

European Journal of Cancer

108

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We investigated the risk factors for venous thrombosis in cancer patients with implantable ports undergoing chemotherapy. One hundred and seventy one ports were placed in a central (''chest ports'') and 84 in a peripheral vein (''arm ports''), 181 received prophylactic nadroparin and 10 coumarin. Clinically overt thrombosis was confirmed by ultrasound or angiography. Catheter-related thrombosis incidence without anticoagulants was 28% in arm and 33% in chest ports, but with anticoagulants this was 32% in arm and only 1% in chest ports (odds ratio (OR) 34.8 95% confidence interval (CI) 7.3-165). Left-sided placement compared with rightsided and catheter tip position in the superior vena cava compared with right atrium were associated with a 3.5 respectively 2.6-fold increased risk. Thrombosis was associated with elevated homocysteine levels (OR = 3.8, 95% CI 1.3-11.3), but not with factor V Leiden or prothrombin 20210A gene mutations, or high concentration of factor VIII, IX or XI. Prophylaxis with anticoagulants is recommended for chest, but not for arm ports. Determination of plasma homocysteine levels may identify patients at an increased risk for thrombosis.

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Section: Discussionmentioning

confidence: 87%

Risk factors for catheter-related thrombosis in cancer patients

Tesselaar¹,

Ouwerkerk²,

Nooy³

et al. 2004

European Journal of Cancer

108

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“…Prothrombotic genetic defects were investigated in 557 children (5 studies). 42,43,70,71,75 Thirtyone events were observed in 113 patients affected by at least one prothrombotic genetic risk factor (factor V 1691GϾA mutation, prothrombin 20210GϾA variant, TT677 methylenetetrahydrofolate reductase [MTHFR] genotype, deficiency of protein C, protein S, antithrombin, elevated lipoprotein [a]). As only one study measured antiphospholipid antibodies (APLAs), 70 this acquired prothrombotic condition was not included in the analysis.…”

Section: Type Of Steroidsmentioning

confidence: 99%

Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients

Caruso

Iacoviello

Castelnuovo

et al. 2006

Blood

336

350

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The risk of thrombosis in children with acute lymphoblastic leukemia (ALL) reportedly ranges between 1% and 37%. Epidemiologic studies have usually been hampered by small numbers, making accurate estimates of thrombosis risk in ALL patients very difficult. The aim of this study was to better estimate the frequency of this complication and to define how the disease, its treatment, and the host contribute to its occurrence. We made an attempt to combine and analyze all published data on the association between pediatric ALL and thrombosis, by using a meta-analytic method. The rate of thrombosis in 1752 children from 17 prospective studies was 5.2% (95% CI: 4.2-6.4). The risk varies depending on several factors. Most of the events occurred during the induction phase of therapy. Lower doses of asparaginase (ASP) for long periods were associated with the highest incidence of thrombosis, as were anthracyclines and prednisone (instead of dexamethasone). The presence of central lines and of thrombophilic genetic abnormalities also appeared to be frequently associated with thrombosis. In conclusion, the overall thrombotic risk in ALL children was significant, and the subgroup analysis was able to identify high-risk individuals, a finding that will hopefully guide future prospective studies aimed at decreasing this risk. IntroductionAcute lymphoblastic leukemia (ALL) is more frequent in children than in adults; indeed, two thirds of all cases occur at pediatric age. 1 The risk of thrombosis is increased in ALL patients, 2 and its occurrence may complicate the treatment course with a negative prognostic impact. Its frequency reportedly ranges between 1.1% and 36.7%, a quite large variation related to several factors, such as different definitions of thrombosis (symptomatic vs asymptomatic), diagnostic methods for its detection, study design (prospective vs retrospective), and differences in treatment protocols. 2 The pathogenesis of this increased thrombotic risk is not fully understood, but includes a combination of variables related to the disease itself, its treatment, and the host. [3][4][5] Although many clinical and epidemiologic studies were performed in this field, the majority were either retrospective or prospective observations on small numbers of subjects. Thus, the results are contradictory and inconclusive, mainly due to lack of statistical power. However, a careful assessment of risk factors would be useful to improve the quality of treatment and to identify subgroups in which prophylactic interventions would be beneficial.The objective of the present study was to quantitatively combine and analyze the available data, by a meta-analytic approach, to obtain accurate estimates of the thrombotic risk in pediatric patients with ALL.Several subgroup analyses were carried out to control for possible biases arising from heterogeneous pieces of information and to sort out subpopulations at higher risk of thrombosis. Materials and methods Meta-analysisIn the PubMed database, all available articles were searched usin...

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“…Four of the six patients with leukemia and thrombosis (67%) but only 21% of leukemia patients without thrombosis had a genetic risk factor (P < 0.013, chi2). No genetic defect was found in the four patients with other solid malignancies and thrombosis (25). A prothrombotic risk factor or a direct cause is identified in about 85% of the patients with sinus thrombosis.…”

Section: Discussionmentioning

confidence: 81%

Cerebral Vein Thrombosis Post Cabg Precipitated by Malposition of Subclavian Central Catheter in Protein C & S Deficiency Patient

Sabzi

Faraji

2015

Ethiop J Health Sci

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BACKGROUND: Cerebral venous thrombosis is an uncommon disorder in the general population. However, it has a higher frequency among patients younger than 40 years , patients with thrombophilia and patients that have foreign body such as catheter in their veins or arterial system. CASE DETAILS: In this case report, we described the clinical and radiological findings of a patient who developed cerebral vein thrombosis post coronary artery bypass grafting secondary undiagnosed protein C and S deficiency which was precipitated by malposition of subclavian central catheter into internal jugular vein. CONCLUSION: We emphasis the importance of radiological veiw of central vein catheter position just after or at the time of cannulation of central vein, not at some hours later as in our case.

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Clinical relevance of genetic risk factors for thrombosis in paediatric oncology patients with central venous catheters

Cited by 95 publications

References 12 publications

Risk factors for catheter-related thrombosis in cancer patients

Risk factors for catheter-related thrombosis in cancer patients

Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients

Cerebral Vein Thrombosis Post Cabg Precipitated by Malposition of Subclavian Central Catheter in Protein C & S Deficiency Patient

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