Risk factors for upper limb deep vein thrombosis associated with the use of central vein catheter in cancer patients

Abstract

Deep vein thrombosis of upper limb is a common complication of CVC in patients with cancer. In these patients the risk factors for CVC-related thrombosis are not completely defined. The purpose of this study was to identify the risk factors for CVC-related thrombosis in patients included in a randomized, double-blind, placebo-controlled study aimed at assessing the efficacy and safety of enoxaparin for the prophylaxis of CVC-related thrombosis. CVC-related thrombosis was screened by mandatory venography after 6 weeks of study treatment. A number of patient baseline characteristics were assessed as potential risk factors for CVC-related deep vein thrombosis. Crude associations between risk factors and clinical outcomes were assessed by chi(2) test or Fisher's exact test. Multiple logistic regression analysis was used to identify independent risk factors. A CVC-related thrombosis was found in 50 out of 310 patients (16.1%). At multiple logistic regression analysis, CVC tip misplaced in the upper half of superior vena cava (OR 4.05, 95%CI 1.64-10.02), left-sided CVC insertion (OR 2.29, 95%CI 1.01-5.51) and chest radiotherapy (OR 7.01, 95%CI 1.42-34.66) were independent risk factors for thrombosis. In addition to these risk factors, the presence of distant metastases (OR 9.36, 95%CI 1.53-57.05) increased the risk of thrombosis in patients who received placebo. An inadequate position of the CVC tip, left-sided CVC insertion and chest radiotherapy are independent risk factors for CVC-related thrombosis in cancer patients. Patients with distant metastases have an increased risk for thrombosis in absence of antithrombotic prophylaxis.

Case Reports: Heritable Thrombophilia Associated with Deep Venous Thrombosis after Shoulder Arthroscopy

“…Upper extremity DVT is an uncommon complication, occurring in less than 4% of patients in whom DVT develops [23]. Risk factors for DVT in this location include acquired or inherited hypercoagulable states, anatomic abnormalities causing venous compression, strenuous upper extremity exercise, cancer, and venous catheterization as with pacemakers [2,7,10,15,21,26,40].…”

Prevention of VTE in Nonsurgical Patients

“…111 Other potential risk factors include left-sided CVC insertion, chest radiotherapy, more than one insertion attempt, and previous CVC insertion. 112,113 A systematic review identifi ed 12 eligible RCTs that enrolled 3,611 patients with cancer and an indwelling CVC 114 and compared prophylactic-dose heparin (LDUH or LMWH) or low-dose VKAs to each other or to no anticoagulation. Most studies administered treatments for a specifi ed fi xed period or until CVC removal or thrombosis diagnosis.…”

Anticancer Drug — Friend or Foe

“…For example, cancer metastases to the bones could cause chronic pain due to the proliferation of cancer cells in the bones and the associated bone remodeling and destruction. Also, tumors that compress veins, the use of central vein catheter, and relative immobility of the patient could lead to deep vein thrombosis with potential pulmonary embolism [44][45][46].…”