Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease

Abstract

We have conducted a prospective randomized controlled trial to evaluate the role of low-dose unfractionated heparin prophylaxis in preventing central venous line-related thrombosis in patients with haemato-oncological disease. Patients were randomly assigned to receive either prophylactic intravenous unfractionated heparin (continuous infusion of 100 IU/kg/daily) or 50 ml/daily of normal saline solution as a continuous infusion. CVLs were externalized, non tunneled, double lumen catheters. All CVLs were placed percutaneously by the same physician in the subclavian vein. Upper limb veins were systematically examined by ultrasonography just before, or <24 hours after, catheter removal, and in case of clinical signs of thrombosis. One hundred and twenty-eight CVLs were inserted. Catheter-related thrombosis occurred in 1.5% of the catheters inserted in patients of the heparin group, and in 12.6% in the control group (p = 0.03). No other risk factors were found for the development of catheter-related thrombosis. Two and three patients experienced severe bleeding in the heparin group, and in the control group, respectively (p = 0.18). There were no other side-effects clearly ascribable to the use of unfractionated heparin. This is the first prospective, randomized study, which shows that low-dose of unfractionated heparin is safe and effective to prevent catheter-related thrombosis in patients with haemato-oncological disease.

Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients

“…[23][24] Recently, in a randomised controlled trial, we showed that low-dose of UFH was safe and effective to prevent CVC-related thrombosis in patients with haemato-oncological disease. 25 However, many clinicians are reluctant to prescribe anticoagulant prophylaxis routinely in patients with cancer and a CVC because of the low expected incidence of thrombosis and the fear of bleeding during anticoagulant prophylaxis. [26][27] In conclusion, our results suggest that inherited prothrombotic abnormalities contribute substantially to CVC-related thrombosis in HSCT recipients.…”

Epidemiology and prevention of catheter‐related thrombosis in patients with cancer

“…The incidence of CRT varies considerably among studies, and has dramatically decreased over time. Earlier studies published in the 1980s and 1990s reported rates as high as 66%, but more recent trials have shown that only 14-18% of patients with cancer and a central venous catheter have evidence of CRT when screening venography or ultrasonography is performed [6,[10][11][12]. Symptomatic CRT occurs much less frequently, at a rate of 5% or lower in prospective cohort studies [13][14][15].…”

“…The efficacy and safety of using anticoagulant prophylaxis to prevent CRT have been investigated in a number of randomized trials (Table 3) [10][11][12][38][39][40][41][42][43][44][45]. The earliest studies suggested that low-dose warfarin (1 mg daily) or LMWH at a standard postoperative prophylaxis dose could significantly reduce the incidence of CRT in cancer patients [38,43].…”

“…The only study showing a significant reduction in CRT used continuous infusion of unfractionated heparin at 100 units kg -1 d -1 in 108 adults and children undergoing bone marrow transplantation [12]. During the 17-month study period, 1.5% of patients who received unfractionated heparin had CRT, as compared with 12.6% of those who did not (P = 0.03).…”

Venous Thrombosis Associated with Peripherally Inserted Central Catheters in Oncology Patients: A Single Institutional Experience

“…In another perspective, only one study showed that the continuous low-dose infusion of heparin (100 U/kg per day) reduces the incidence of PICC-associated thrombosis to 1.5%. This finding is attributed to the higher incidence of chemotherapy-induced thrombocytopenia [13]. Many risk factors for PICC-related thrombosis were analyzed in several studies such as obesity, gender, history of DVTs and use of anticoagulation but none were conclusive and only revealed conflicting results [14][15][16][17].…”