Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis

Abstract

Background: Recent guidelines do not recommend antithrombotic prophylaxis (AP) to prevent catheter-related thrombosis in cancer patients with a central line. Patients and methods:This study assessed the management of central lines in cancer patients, current attitude towards AP, catheter-related and systemic venous thromboses, and survival.Results: Of 1410 patients enrolled, 1390 were seen at least once in the 6-month median follow-up. Continuous AP, mainly low-dose warfarin, was given to 451 (32.4%); they were older, with a more frequent history of venous thromboembolism (VTE), and more advanced cancer. There was no difference in catheter-related thrombosis in patients given AP or not (2.8% and 2.2%, odds ratio 1.29, 95% confidence interval 0.64-2.6). The median time to first catheter-related complication was 120 days. Systemic VTE including deep and superficial thromboses and pulmonary embolism, were less frequent with AP (4% versus 8.2%, P = 0.005). Mortality was also lower (25% versus 44%, P = 0.0001). Multiple logistic regression analysis found only advanced cancer and no AP significantly associated with mortality. No major bleeding was recorded with AP.Conclusions: Current AP schedules do not appear to prevent catheter-related thrombosis. Systemic VTE and mortality, however, appeared lower after prophylaxis.

The impact of antithrombotic prophylaxis on infectious complications in cancer patients with central venous catheters: an observational study

“…During follow-up, a record was kept of any catheterrelated complication, for example, pneumothorax, catheter malposition, infection, catheter breakage, disconnection, or occlusion (one-way flow only, or unusable for blood sampling or infusion), tip or sleeve thrombosis, deep venous thrombosis (DVT) at the catheter site (on the subclavian/jugular and superior caval sites), or systemic thromboembolic events as defined elsewhere [11], decubitus sores, bleeding, removal of the CVD, and course of the neoplastic disease.…”

“…Patients' descriptions and the study procedure were reported in the previous paper [11]. Briefly, patients were eligible if they had solid or hematological tumors, were aged over 18 years, and had a CVD: either a totally implantable CVD (port), or an indwelling central venous catheter (CVC), or a peripherally inserted catheter (PICC).…”

“…The results cover a broad series of strictly consecutive patients, and therefore give a fairly reliable picture of Italian oncologists' attitudes. In an earlier report [11], we described the encouraging impact of antithrombotic prophylaxis on systemic venous thrombotic complications and on survival. Here we present the findings regarding infectious complications and how they appear to be affected by antithrombotic prophylaxis.…”

Vascular Access in Oncology Patients

“…However, more studies are needed to identify subsets of cancer patients who are at high risk of developing CVC thrombosis and may benefit from prophylactic systemic anticoagulation. Indeed, in a recent observational study, 88 compared with patients with no treatment, continuous antithrombotic prophylaxis administered to patients who were older and had a history of venous thromboembolism, as well as more advanced cancer, did not prevent catheter-related thrombosis but significantly reduced systemic venous thromboembolism (8.2% versus 4%) and mortality (44% versus 25%). The Italian Study Group for Long Term Central Venous Access 78 suggests considering prophylaxis with a single daily dose of LMWH (eg, enoxaparin 100 IU/kg) in high-risk patients, including those who have a family history of thrombotic events or previously suffered from idiopathic venous thrombotic events.…”

Management of venous thromboembolism in colorectal cancer patients treated with bevacizumab

“…Many VTEs, although asymptomatic, can be as serious as PEs in terms of morbidity [9,10]. Based on the results of studies on the prevention of catheter-related thrombosis, anticoagulant prophylaxis is not generally recommended with a CVAS [11][12][13].…”