Implanted vascular access device related deep vein thrombosis in oncology patients: A prospective cohort study

Abstract

A B S T R A C TBackground: Implanted vascular access devices (IVADs) have significantly improved the management of cancer patients. These patients are at an increased risk of venous thromboembolism and IVADs are a known risk factor. We sought to assess the incidence of IVAD-related upper extremity deep vein thrombosis (IVAD-related UEDVT) associated with BioFlo® IVADs (Angiodynamics, Inc.). Methods: A total of 394 cancer patients were enrolled over 12 months. The primary outcome was the incidence of IVAD-related UEDVT confirmed by diagnostic imaging. IVAD-related UEDVT was defined as symptomatic ipsilateral upper extremity (axillary vein or proximal) deep vein thrombosis and symptomatic pulmonary embolism (PE). Patients were followed until initiation of therapeutic anticoagulation, catheter removal, death, or up to 12 months. Results: 389 patients were included in the analysis. The median age of the cohort was 58.2 years; 68% (n = 273) were females. Sixty-six percent had gastrointestional cancer (including pancreatic cancer) and 68% had metastases. Eighty four percent of IVADs were right sided insertions. Ninety eight percent of catheter tip placements were distal superior vena cava (n = 237), cavo-atrial junction (n = 67) or atrium (n = 90). Overall, 5 patients had symptomatic IVAD-related UEDVT (1.29%, 95% CI 0.2 to 2.4%). Conclusion: IVAD-related UEDVT is an infrequent complication in cancer patients with BioFlo® IVADs.Prevention of an IVAD-related UEDVT in the oncology population is crucial. Some IVADs are constructed with catheter tubing composed of a novel anti-thrombogenic polymer which has been shown in in-vitro to reduce thrombus accumulation [12]. We sought to assess the incidence of IVAD-related UEDVT associated with BioFlo® IVADs (Angiodynamics, Inc.) constructed with this material. Methods SettingWe conducted a prospective cohort study of consecutive cancer patients receiving an IVAD for the administration of chemotherapy between August 2015 and September 2017 at The Ottawa Hospital. The

Characteristics of Symptomatic Axillary Vein Thrombosis After Placement of Totally Implanted Venous Access Port in Cancer Patients

“…Piran et al (14) reported that the rate of symptomatic venous thrombosis was 4.5%; all implanted ports were inserted via the internal jugular vein without mention of catheter size. Suleman et al (15) reported the rate of TIVAP-related venous thrombosis was 1.29% after implantation of the TIVAP via the internal jugular vein with 8Fanti-thrombogenic polymer catheter. Tabatabaie et al (16) reported that the rate of TIVAP-related venous thrombosis was 1.81% (926/51,049); however, information was not provided regarding the diameter and material of the catheter or access route.…”

<p>Development of 13-Cys-BBR as an Agent Having Dual Action of Anti-Thrombosis and Anti-Inflammation</p>

“…Arterial thrombus weight was used to represent the antiarterial thrombotic activity and measured on Sprague Dawley rat model (male, 240-270 g, each 10) by following the procedure of the literature. 25 In this assay 0.5% CMC-Na (blank control, oral dose: 10 mL/kg) or a suspension of aspirin in 0.5% CMC-Na (positive control, oral dose: 167 µmol/kg) or a suspension of 13-Cys-BBR in 0.5% CMC-Na (oral dose: 66.7 nmol/kg) or a suspension of BBR in 0.5% CMC-Na (parent compound control, oral dose: 66.7 nmol/kg) were given to the rats. 30 min after oral administration the rat was anaesthetized with sodium pentobarbital (80.0 mg/kg, ip), then the right carotid artery and left jugular vein of the rat were separated.…”

“…Venous thrombus weight was used to represent the anti-venous thrombotic activity and measured on Sprague Dawley rat model (male, 240-270 g, each 12) by following the procedure of the literature. 25 Inferior vena cava (IVC) ligation model was used to evaluate the activity. In brief, rats were orally given 0.5% CMC-Na (blank control, oral dose: 10 mL/kg) or a suspension of warfarin in 0.5% CMC-Na (positive control, oral dose: 4870 nmol/kg) or a suspension of 13-Cys-BBR in 0.5% CMC-Na (oral dose: 66.7 nmol/kg) or a suspension of BBR in 0.5% CMC-Na (parent compound control, oral dose: 66.7 nmol/kg).…”

“…To compare the feature of 13-Cys-BBR and BBR in the active sire of P-selectin the docking investigation was performed by using the procedure of the literature. 25 In brief, the conformations of 13-Cys-BBR and BBR (parent compound control) were generated and energy-optimized. Ten energy-optimized conformations of BBR and 13-Cys-BBR were selected and individually docked into the active site of P-selectin by using CDOCKER protocol to get docking scores.…”

Disease-Related Risk Factors for CVC-Related Symptomatic Thrombosis in Surgical ICU Inpatients

“…Hospital-acquired venous thromboembolism (VTE) has received increasing attention in medical institutions due to its increased morbidity and mortality among hospitalized patients [1][2][3][4] . A number of studies have identi ed several important risk factors for hospital-acquired thrombus, of which CVC is an important risk factor [5][6][7] . Symptomatic CRVT is a special type of hospital-acquired VTE.…”