Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta‐analysis

Abstract

Background Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP‐associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta‐analysis. Methods Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP‐related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. Results In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24‐3.28), and 0.08 (95 CI: 0.06‐0.10) per 1000 catheter‐days. This risk was highest when TIVAPs were inserted via the upper‐extremity vein (3.54%, 95% CI: 2.94‐4.76). Our meta‐analysis of the case‐control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09‐0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37‐1.50). Meta‐regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. Conclusions Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper‐extremity veins as the insertion site.

Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

“…A recent retrospective cohort study of 83 patients hospitalized for DVT showed that 72 cases were LEDVT and 11 cases were UEDVT [33]. Foreign bodies in the vascular system are the most important independent risk factors of DVT [34][35][36]. A study of the general population showed that LEDVT occurred in 372 of 3790 patients inserted with PICCs during hospitalization [3].…”

Peripherally Inserted Central Venous Catheter in Upper Extremities Could be a Risk for Deep Vein Thrombosis in Lower Extremities and D-Dimer in Neurology Department

“…Foreign body in vascular system is the most important independent risk factor of upper extremities deep vein thrombosis (UEDVT) [27][28][29][30]. CVC increased the risk of UEDVT by 7 times (odd ratio [or] 7.3, 95% con dence interval [5.79, 9.21]; P < 0.0001) [29].…”

Published trends and research hotspots of central venous catheter-associated thrombosis from 1973 to 2022: A scientometric analysis

“…Studies on CVC-RT have been carried out at all ages from infants to older adults [4,7,[17][18][19] and in different clinical settings, especially in oncology departments. [8,[20][21][22][23] Currently, insertion of CVCs has become a common practice in the oncology hematology department for systemic therapy. [24] However, the occurrence of CVC complications has an important impact on the care-pathway.…”