Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial

Karthaus, Meinolf; Kretzschmar, Albrecht; Kröning, H.; Biakhov, M.; Irwin, David; Marschner, Norbert; Slabber, C.; Fountzilas, George; Garin, A.; Abecasis, Nuno; Baronius, W; Steger, G.; Südhoff, Thomas; Giorgetti, C.; Reichardt, Peter

doi:10.1093/annonc/mdj059

Cited by 202 publications

(136 citation statements)

References 28 publications

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“…144 For prevention of CVAD-associated VTE, randomized controlled studies have not established the efficacy of prophylactic doses of LMWH or lowdose warfarin (1 mg daily). [145][146][147] A recent randomized trial showed that dose-adjusted warfarin (INR, 1.5-2.0; n=473) was significantly more effective than fixed-dose warfarin (1 mg daily; n=471) in preventing CVAD-associated VTE at a cost of a trend toward more bleeding; however, a separate comparison of warfarin (fixed 1-mg dose, n=324; adjusteddose, INR1.5-2, n=84) with placebo (n=404) did not demonstrate a statistically significant reduction in VTE. 148 These data suggest therapeutic or neartherapeutic doses of anticoagulation will likely be necessary for the successful prevention of CVADassociated VTE.…”

Section: Vte Prophylaxismentioning

confidence: 99%

Venous Thromboembolic Disease

Streiff¹,

Bockenstedt²,

Cataland³

et al. 2013

J Natl Compr Canc Netw

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OverviewVenous thromboembolism (VTE) is a common and life-threatening condition in patients with cancer.1,2 Results from a retrospective study of hospitalized adult patients with cancer with neutropenia (N=66,106) showed that approximately 3% to 12% of these patients, depending on the type of malignancy, experienced VTE during their first hospitalization.1 In a recent health claims database analysis of patients undergoing chemotherapy for solid tumors in the ambulatory setting (N=17,284), VTE NCCN Venous Thromboembolic Disease Clinical Practice Guidelines in Oncology AbstractVenous thromboembolism (VTE) remains a common and life-threatening complication among patients with cancer. Thromboprophylaxis can be used to prevent the occurrence of VTE in patients with cancer who are considered at high risk for developing this complication. Therefore, it is critical to recognize the various risk factors for VTE in patients with cancer. Risk assessment tools are available to help identify patients for whom discussions regarding the potential benefits and risks of thromboprophylaxis would be appropriate. The NCCN Clinical Practice Guidelines in Oncology for VTE provide recommendations on risk evaluation, diagnosis, prevention, and treatment of VTE in patients with cancer. (JNCCN 2013;11:1402-1429 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Vte Prophylaxismentioning

confidence: 99%

Venous Thromboembolic Disease

Streiff¹,

Bockenstedt²,

Cataland³

et al. 2013

J Natl Compr Canc Netw

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“…[85][86][87] The choice to start prophylaxis against venous thromboembolic events in all oncology patients bearing a CVC, either with LMWH or with minidose warfarin, remains unsupported by evidence-based medicine. However, more studies are needed to identify subsets of cancer patients who are at high risk of developing CVC thrombosis and may benefit from prophylactic systemic anticoagulation.…”

Section: Thrombosismentioning

confidence: 99%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

253

166

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Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

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“…The outpatient prophylaxis score developed by Khorana et al 4 (Table iii) and validated in randomized trials identifies cancer patients at risk for vte. Anticoagulants tested in cancer patients include dalteparin, enoxaparin, tinzaparin, semuloparin, certoparin, bemiparin, nadroparin, and warfarin [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] , of which enoxaparin, dalteparin, and tinzaparin are readily available in Canada. A Cochrane systematic review 43 of 21 rcts that included 9861 ambulatory patients with cancer receiving chemotherapy showed that, compared with inactive control and warfarin, low molecular weight heparin (lmwh) was associated with a 45% reduction in the overall vte incidence [risk ratio: 0.55; 95% confidence interval (ci): 0.34 to 0.88; p < 0.05] and a nonsignificant increase in bleeding.…”

Section: Prophylaxis In Ambulatory Cancer Patientsmentioning

confidence: 99%

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

Easaw

Shea‐Budgell

et al. 2015

Current Oncology

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Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic.PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations.Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended.

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Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial

Abstract: Dalteparin prophylaxis did not reduce the frequency of thromboembolic complications after CVC implantation in cancer patients. Dalteparin was demonstrated to be safe over 16 weeks of treatment in these patients.

Cited by 202 publications

References 28 publications

Venous Thromboembolic Disease

Venous Thromboembolic Disease

Vascular Access in Oncology Patients

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

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