Etiology and Management of Upper-Extremity Catheter-Related Thrombosis in Cancer Patients

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2010.04126.x ◽

2011 ◽

Vol 9 (2) ◽

pp. 312-319 ◽

Cited By ~ 120

Author(s):

W. SABER ◽

T. MOUA ◽

E. C. WILLIAMS ◽

M. VERSO ◽

G. AGNELLI ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trials ◽

Cancer Patients ◽

Prospective Studies ◽

Meta Analysis ◽

Patient Level Data ◽

Patient Level ◽

Level Data ◽

Catheter Related Thrombosis

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The long-term risk of upper-extremity lymphedema is two-fold higher in breast cancer patients than in melanoma patients

Journal of Surgical Oncology ◽

10.1002/jso.24068 ◽

2015 ◽

Vol 112 (8) ◽

pp. 834-840 ◽

Cited By ~ 11

Author(s):

Rachel K. Voss ◽

Kate D. Cromwell ◽

Yi-Ju Chiang ◽

Jane M. Armer ◽

Merrick I. Ross ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Upper Extremity ◽

Breast Cancer Patients ◽

Melanoma Patients

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Baseline Inflammatory Markers Are Associated with Upper Extremity Lymphedema in Breast Cancer Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.1692 ◽

2020 ◽

Vol 108 (3) ◽

pp. e542-e543

Author(s):

D. Garner ◽

S.M. DeSnyder ◽

L. Isales ◽

W.A. Woodward ◽

L. Colbert ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Upper Extremity ◽

Inflammatory Markers ◽

Breast Cancer Patients

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Early and short-term acenocumarine or dalteparin for the prevention of central vein catheter-related thrombosis in cancer patients: a randomized controlled study based on serial venographies

Annals of Oncology ◽

10.1093/annonc/mdp235 ◽

2009 ◽

Vol 20 (12) ◽

pp. 1936-1942 ◽

Cited By ~ 37

Author(s):

M. De Cicco ◽

M. Matovic ◽

L. Balestreri ◽

A. Steffan ◽

R. Pacenzia ◽

...

Keyword(s):

Cancer Patients ◽

Randomized Controlled Study ◽

Controlled Study ◽

Central Vein ◽

Short Term ◽

Randomized Controlled ◽

Vein Catheter ◽

Central Vein Catheter ◽

Catheter Related Thrombosis

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Upper-extremity deep vein thrombosis related to central venous port systems implanted in cancer patients

British Journal of Radiology ◽

10.1259/bjr/41019720 ◽

2010 ◽

Vol 83 (994) ◽

pp. 850-853 ◽

Cited By ~ 14

Author(s):

S Yukisawa ◽

Y Fujiwara ◽

Y Yamamoto ◽

T Ueno ◽

K Matsueda ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Cancer Patients ◽

Upper Extremity ◽

Central Venous ◽

Vein Thrombosis ◽

Central Venous Port ◽

Venous Port ◽

Port Systems ◽

Deep Vein

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The Risk of Deep Venous Thrombosis and Sepsis in Cancer Patients Due to PICC Lines.

Blood ◽

10.1182/blood.v104.11.4082.4082 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4082-4082

Author(s):

Lee Lin ◽

Stanley Walker

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cancer Patients ◽

Upper Extremity ◽

Retrospective Chart Review ◽

Small Population ◽

Average Patient ◽

Cancer Types ◽

Picc Line

Abstract Context Upper extremity deep venous thrombosis (DVT) represents 8–10% of total DVT of the limb. Long term central venous catheters represent a major cause of upper extremity DVT, especially in cancer patients. This study looks specifically at the risk posed by peripherally inserted central catheters (PICC). Purpose of the Study: To assess the risk of DVT and sepsis due to PICC lines in cancer patients as compared to non-cancer patients. Furthermore, to assess the risk of PICC line related DVT and sepsis among different cancer types. Design, Setting, and Patients: Retrospective chart review of all 190 patients (representing n=244 procedures) who had undergone a PICC line procedure in Union Memorial Hospital (Baltimore, MD) from August 2003 to December 2003. Based on their medical records, it was determined whether or not the patient had experienced PICC line related sepsis or thrombosis. Cancer as a potential risk factor was included in the information collected. 33 of 190 patients were cancer patients. Average patient age 56.7 years. Results: Preliminary results show that from August 1, 2003 to December 5, 2003, among the non-cancer patients 6 (3.8%) patients with DVT and 6 (3.8%) patients with sepsis were identified. Among the cancer patients, 3 (9.1%) patients with DVT and 3 (9.1%) patients with sepsis were identified. Though cancer patients made up only 17.4% of the patient population, they represented 33.3% of the cases of DVT and sepsis. Conclusion: Cancer patients are at a greater risk of thromboses and sepsis due to PICC lines as compared to non-cancer patients. Cancer patients, therefore, represent a unique population of PICC line patients who may require a different protocol of prophylaxis and complication prevention. While different types of cancers may pose different levels of risk (Sorensen et al), this could not be determined with confidence with the preliminary findings due to the small population evaluated so far. Non-cancer patients Cancer patients DVT 6 3.8% Sepsis 6 3.8% DVT 3 9.1% Sepsis 3 9.1%

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Development and validation of a new clinical prediction model of catheter-related thrombosis in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14031 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14031-e14031

Author(s):

Binliang Liu ◽

Junying Xie ◽

Xiaoying Sun ◽

Yanfeng Wang ◽

Zhong Yuan ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Prediction Model ◽

Receiver Operating Characteristic ◽

Cancer Patients ◽

Retrospective Cohort ◽

Operating Characteristic ◽

Risk Group ◽

Cancer Center ◽

Catheter Related Thrombosis

e14031 Background: The central venous catheter brings convenience for drug delivery and improves comfort for cancer patients, it also causes serious complications. The most common one is catheter-related thrombosis (CRT). This study aimed to evaluate the incidence and risk factors of CRT in cancer patients, and to develop an effective prediction model for CRT in cancer patients. Methods: The development of our prediction model was based on the data of a retrospective cohort (n = 3131) from National Cancer Center. The validation of our prediction model was done in a prospective cohort from National Cancer Center (n = 685) and a retrospective cohort from Hunan Cancer Hospital (n = 61). The predictive accuracy and the discriminative ability were determined by the receiver operating characteristic curves and calibration plots. Results: Multivariate analysis demonstrated that sex, cancer type, catheter type, position of the catheter tip, chemotherapy status, and antiplatelet/anticoagulation status at baseline were independent risk factors for CRT. The area under receiver operating characteristic (ROC) curve of our prediction model was 0.741 (CI: 0.715-0.766) in the primary cohort; 0.754 (CI: 0.704-0.803) and 0.658 (CI: 0.470-0.845) in validation cohorts respectively. Good calibration and clinical impact were also shown in primary and validation cohorts. The high-risk group had a higher incidence of CRTs than the low-risk group in the primary cohort and two validation cohort (p < 0.001). Conclusions: Our model is a novel prediction tool for CRT risk which helps to assigning cancer patients into high-risk or low-risk group accurately. Our model will be valuable for clinicians in decision making of thromboprophylaxis.

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