Incidence and outcomes of catheter related thrombosis (CRT) in patients with acute leukemia using a platelet-adjusted low molecular weight heparin regimen

Htun, Kay T; Mabel, J Y; Lee, Agnes Y.Y.

doi:10.1007/s11239-018-1711-5

Cited by 24 publications

(14 citation statements)

References 31 publications

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“…Thirty-five studies were evaluated as full text, and 20 of these with a total of 1473 patients were included in the analysis (Table 1). 15,21,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Study size ranged from 10 to 210 patients. Eleven studies were prospective and nine had a retrospective design.…”

Section: Re Sultsmentioning

confidence: 99%

Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta‐analysis

Valeriani

Nisio

Porceddu

et al. 2022

Journal of Thrombosis and Haemostasis

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Background Data on anticoagulant treatment for upper extremity deep vein thrombosis (UEDVT) are largely derived from studies on usual site venous thromboembolism (VTE). Objectives The objective of this meta‐analysis was to evaluate the efficacy and safety of anticoagulant therapy for UEDVT. Patients/Methods A systematic search of MEDLINE and EMBASE was conducted for studies including patients with UEDVT. Primary outcomes were recurrent VTE and major bleeding. Secondary outcomes included clinically‐relevant non‐major bleeding and all‐cause mortality. Summary estimates with 95% confidence intervals (CIs) were calculated by random‐effect meta‐analysis. Results A total of 1473 patients from 11 prospective and nine retrospective studies were included. Sixty percent of patients had an indwelling catheter and 56.1% had cancer. Anticoagulant treatment consisted of direct oral anticoagulants, low molecular weight heparin followed by vitamin K antagonists, and low molecular weight heparin alone in 45.1%, 35.0%, and 19.9% of patients, respectively. During a median follow‐up of 13 months, recurrent VTE occurred in 3% of patients (95% CI: 2–4; 21/1334 patients), major bleeding in 3% (95% CI: 2%–5%; 29/1235 patients), clinically‐relevant non‐major bleeding in 4% (95% CI: 3–6; 40/1075 patients), and all‐cause mortality in 9% (95% CI: 5–15; 108/1084 patients). Rates of these outcomes were not significantly different between patients with or without cancer, patients with or without an indwelling catheter, and among those receiving different anticoagulant treatments. Conclusions In patients with UEDVT, anticoagulant treatment is associated with a low risk of recurrent VTE and a nonnegligible risk of major bleeding.

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Section: Re Sultsmentioning

confidence: 99%

Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta‐analysis

Valeriani

Nisio

Porceddu

et al. 2022

Journal of Thrombosis and Haemostasis

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“…42 We found that 11% of pediatric cancer patients with a catheter inserted suffered from CVC-related VTE, which is considered equal to that of adults. 9,10 The incidence of CVC-related VTE in adults with ALL has been reported to range from 6.5 to 11.7%, 43,44 and from 3.8 to 13% in adults with solid tumors and a catheter. 45,46 Five studies described specifically CVC-related VTE in 459 children with ALL and 69 CVC-related VTE (15%).…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism in Pediatric Cancer Patients with Central Venous Catheter—A Systematic Review and Meta-analysis

Hansen

Nybo

Hvas

2021

Semin Thromb Hemost

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Pediatric cancer patients hold an increased risk of venous thromboembolism (VTE) due to their cancer. Central venous catheters (CVCs) further increase the VTE risk. This systematic literature review elucidates the VTE incidence in pediatric cancer patients with CVC. MEDLINE and EMBASE were searched in August 2020 without time limits. We included studies reporting original data on patients ≤18 years with any CVC type and any cancer type, who were examined for VTE with ≥7 days follow-up. In total, 682 unique records were identified, whereof 189 studies were assessed in full text. Altogether, 25 studies were included, containing 2,318 pediatric cancer patients with CVC, of which 17% suffered VTE. Fifteen studies (n = 1,551) described CVC-related VTE and reported 11% CVC-related VTE. Concerning cancer type, 991 children suffered from acute lymphoblastic leukemia (ALL) and 616 from solid tumors. Meta-analysis revealed VTE incidence (95% confidence interval) of 21% (8–37) for ALL and 7% (0.1–17) for solid tumors. Additionally, 20% of children with tunneled or nontunneled CVC and 12% of children with implantable ports suffered VTE. In conclusion, pediatric cancer patients with CVC have substantial VTE risk. Children with ALL and CVC have higher VTE incidence than children with solid tumors and CVC. Implantable port catheter should be preferred over tunneled or nontunneled CVC to reduce VTE risk. Thrombophilia investigation does not seem relevant in pediatric cancer patients with CVC and VTE. To prevent VTE, intensified catheter care is recommended, especially in children with ALL.

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“…In such patients, platelet count-adjusted LMWH dosing (in acute VTE) or temporarily withholding anticoagulation (in chronic VTE) are reasonable options. 10,11 A retrospective management study supports an individualized, risk-adapted approach to cancer patients with acute VTE and thrombocytopenia. While subtherapeutic LMWH dosages were generally preferred in patients with platelet counts of less than 100 Â 10 9 /L or the presence of cerebral metastasis, patients with PE or symptomatic VTE were more likely to receive therapeutic-dose anticoagulation.…”

Section: Management Of Venous Thromboembolismmentioning

confidence: 94%

Management of Vascular Thrombosis in Patients with Thrombocytopenia

Voigtlaender

2021

Hamostaseologie

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Platelets play critical roles in hemostasis and thrombosis. While low platelet counts increase the risk of bleeding, antithrombotic drugs, including anticoagulants and antiplatelet agents, are used to treat thromboembolic events. Thus, the management of thrombosis in patients with low platelet counts is challenging with hardly any evidence available to guide treatment. Recognition of the underlying cause of thrombocytopenia is essential for assessing the bleeding risk and tailoring therapeutic options. A typical clinical scenario is the occurrence of venous thromboembolism (VTE) in cancer patients experiencing transient thrombocytopenia during myelosuppressive chemotherapy. In such patients, the severity of thrombocytopenia, thrombus burden, clinical symptoms, and the timing of VTE relative to thrombocytopenia must be considered. In clinical practice, distinct hematological disorders characterized by low platelet counts and a thrombogenic state require specific diagnostics and treatment. These include the antiphospholipid syndrome, heparin-induced thrombocytopenia (HIT) and (spontaneous) HIT syndromes, disseminated intravascular coagulation, and paroxysmal nocturnal hemoglobinuria.

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Incidence and outcomes of catheter related thrombosis (CRT) in patients with acute leukemia using a platelet-adjusted low molecular weight heparin regimen

Cited by 24 publications

References 31 publications

Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta‐analysis

Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta‐analysis

Venous Thromboembolism in Pediatric Cancer Patients with Central Venous Catheter—A Systematic Review and Meta-analysis

Management of Vascular Thrombosis in Patients with Thrombocytopenia

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