Risk Factors for Central Venous Line-Related Deep Vein Thrombosis and Occlusions in the Israeli Pediatric Oncology Registry.

Abstract The use of central venous lines (CVLs) has greatly improved the quality of care in children with cancer, yet these catheters may cause serious mechanical, infectious and thrombotic complications, both deep vein thrombosis (DVT) and catheter occlusion. The aim of this prospective study is to ascertain the incidence of thrombotic complications and their risk factors. A registry was started in June 2006 for all children undergoing CVL insertion for treatment of cancer in the three largest pediatric cancer centers in Israel. After informed consent was signed, a registration form, that included questions regarding demographic-, clinical- and CVL-related data, and family history of thrombosis, was completed. Blood samples for baseline thrombophilia work-up, i.e. protein C, protein S, anti-thrombin, APCR, Factor V Leiden, Prothrombin gene mutation and MTHFR, were collected with separate consent. The following events were reported to the registry: immediate post insertion complications, venous thrombosis confirmed by imaging, occlusion of the CVL, i.e. inability to infuse and/or withdraw blood, requiring medical or surgical intervention, and CVL infections. The maintenance of CVLs and management of CVL occlusion and infection remained in accordance with institutional protocols. Responsible oncologists decided whether a dysfunctional or an infected CVL was to be removed or replaced, and whether radiographic evaluation for thrombotic complications was indicated. Patients were enrolled until December 2007, and data analysis was completed in June 2008. A total of 414 CVLs, i.e. peripherally inserted central catheters (PICCs) (45%), Hickman catheters (25%) and Port-a-Caths (30%), were inserted into 262 children for a total of 71,241 catheter-days. Fourteen events of venous thrombosis occurred in 13 children (4.9%, 95% confidence interval (CI) 2.6% to 8.3%), including 10 events of CVL-related DVT. The occurrence of CVL-related DVT was significantly higher for PICCs, 4.5%, compared to other types of CVLs, 0.9% (p=0.02, odds ratio (OR) 5.4 (95% CI 1.13 to 25.8)). CVL-related DVT was not associated with age at diagnosis, side of insertion (right vs. left), vessel cannulated, type of cancer (acute lymphoblastic leukemia vs. others), ethnic origin or family history of thrombosis. Occlusion of the CVL occurred at least once in 90 children (34%, 95% CI 29% to 40%). Children with family history of thrombosis were more likely to have CVL occlusion, 62.5%, compared to children without family history of thrombosis, 30.4% (P=0.01, OR 3.8 (95% CI 1.3 to 10.8)). Occlusion was reported in 102 CVLs (24%, 95% CI 20% to 28%). The occurrence of occlusion was higher for Port-a-Caths, 42%, and Hickman catheters, 35%, compared to PICCs, 23% (P<0.01, OR 6.64 (95% CI 2.98 to 14.8) and 4.62 (95% CI 1.84 to 11.6), respectively). CVL-related DVT was not associated with occlusion. Until now, thrombophilia screening has been completed in 85 children (32%), 21 of whom had a positive screen (25%, 95% CI 16% to 35%). A positive thrombophilia screen was found more frequently in children of Arabic origin, 43%, compared to children of Jewish origin, 13% (P=0.006), but was not associated with CVL-related DVT or occlusion. Also, in a subgroup analysis of the children with thrombophilia testing (n=85), children with a family history of thrombosis were more likely to have occlusion compared to children without a family history of thrombosis, 100% vs. 37%, respectively (P=0.01, Bonferroni post-oc correction). Our prospective study shows that insertion of PICCs significantly increases the risk for symptomatic CVL-related thrombosis; other risk factors were not found to be significant. The lower rate of PICC occlusions might be explained by their use for shorter time periods. Interestingly, a positive family history of thrombosis rather than a positive thrombophilia screen was found to be a risk factor for CVL occlusion; perhaps the standard thrombophilia screening is not sensitive enough to detect inherited risk of thrombosis associated with CVLs. The long-term effect of CVL occlusion as a predictor for under-diagnosed CVL-related thrombosis will be determined by following our cohort for development of post-thrombotic syndrome.

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Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters

VASA ◽

10.1024/0301-1526/a000217 ◽

2012 ◽

Vol 41 (5) ◽

pp. 319-332 ◽

Cited By ~ 16

Author(s):

Linnemann ◽

Lindhoff-Last

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Vein Thrombosis ◽

Palliative Care Setting ◽

Thrombotic Complications ◽

Randomised Controlled ◽

Deep Vein

An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.

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Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

European Journal of Pediatrics ◽

10.1007/s00431-021-03985-5 ◽

2021 ◽

Author(s):

Miguel García-Boyano ◽

José Manuel Caballero-Caballero ◽

Marta García Fernández de Villalta ◽

Mar Gutiérrez Alvariño ◽

María Jesús Blanco Bañares ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Vein Thrombosis ◽

Venous Access Device ◽

Deep Vein

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Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619852167 ◽

2019 ◽

Vol 25 ◽

pp. 107602961985216 ◽

Cited By ~ 2

Author(s):

Mert Özcan ◽

Murat Erem ◽

Fatma Nesrin Turan

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Medical History ◽

Symptomatic Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Contraceptive Usage ◽

Venous Thromboembolic Events ◽

History Of ◽

Deep Vein ◽

Previous Medical History

Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients.

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The Natural History of Idiopathic Erythrocythosis: A Cohort Study of 74 Patients.

Blood ◽

10.1182/blood.v104.11.1506.1506 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1506-1506

Author(s):

Finazzi Guido ◽

Ruggeri Marco ◽

Marconi Monica ◽

Rodeghiero Francesco ◽

Barbui Tiziano

Keyword(s):

Cohort Study ◽

Deep Vein Thrombosis ◽

Natural History ◽

Thrombotic Event ◽

Previous History ◽

Full Blood Count ◽

Vein Thrombosis ◽

History Of ◽

Thrombotic Complications ◽

Deep Vein

Abstract Patients with absolute erythrocytosis not due to a detectable cause and not fulfilling the criteria for diagnosis of polycythemia vera (PV) are descriptively classified as Idiopathic Erythrocytosis (IE). Based on scanty and retrospective data, this disease is considered to be an heterogeneous entity, including “early” PV, unrecognized secondary erythrocytosis and other miscellaneous conditions. However, appropriate prospective studies to evaluate the natural history of patients with IE are not available. We report here the results of a cohort study of 74 patients with IE (66 males, 8 females, median age 56 years, range 14–82) followed in two Italian institutions. By definition, at baseline all IE patients had increased hematocrit (median 54%, range 48–68%) and increased red blood cell mass (> 25% above mean normal predicted value), but normal leukocyte (median values 8.1 x 109/L, range 2.3–12) and platelet counts (median values 197 x 109/L, range 117–467), as well as normal erythropoietin level, arterial O2 saturation, chest X ray and abdominal ultrasound scanning (i.e. no splenomegaly). Granulocyte PRV-1 expression was also normal in 29 patients (39%) analyzed. At diagnosis, 12 patients (16%) reported a previous history of major thrombosis (7 ischemic cardiopathies, 4 cerebral ischemic events and 1 deep vein thrombosis). All IE patients were treated with phlebotomy to maintain a target hematocrit <45% and 24 patients (32%) were given aspirin, 100 mg/die, for previous thrombosis or microvascular symptoms. No cytotoxic drugs were given. The IE cohort was followed in the outpatient clinic with physical examination and full blood count at least every three months for a median period of 3.5 years (range 1–23). Twentythree patients (31%) were followed for more than 8 years. No patient was lost to follow-up. During the observation period, no disease potentially associated with secondary eryhtrocytosis emerged and no hematological transition into overt PV, myelofibrosis or acute leukemia occurred; two patients had a major thrombotic event (1 cerebral ischemia and 1 deep vein thrombosis) with an estimated incidence of thrombotic complications of 0.8% patient-year. The incidence of thrombosis was significantly lower than observed in 205 patients with overt PV followed during the same period in one of the two institutions (Bergamo, 3.49% patient-year, p<0.05). This study indicates that: a. the natural history of patients with IE, at least in the first years, is characterized by a remarkable and unexpected homogeneity without appearance of overt PV or diseases associated with secondary erythrocythosis; b. the diagnosis of IE identifies a group of absolute erythrocythoses at lower risk of thrombotic complications not requiring cytotoxic drug therapy; c. the diagnostic work-up of patients with absolute erythrocythosis should carefully distinguish IE from PV because the natural history and management of the two diseases is different.

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Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽

10.1182/blood.v106.11.584.584 ◽

2005 ◽

Vol 106 (11) ◽

pp. 584-584

Author(s):

Frederick A. Spencer3 ◽

Robert J. Goldberg ◽

Darleen Lessard ◽

Cathy Emery ◽

Apar Bains ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Central Venous Catheter ◽

Lower Extremity ◽

Upper Extremity ◽

Venous Catheter ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

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Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography

Journal of Intensive Care Medicine ◽

10.1177/0885066618813300 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1062-1066 ◽

Cited By ~ 2

Author(s):

Charlisa D. Gibson ◽

Mai O. Colvin ◽

Michael J. Park ◽

Qingying Lai ◽

Juan Lin ◽

...

Keyword(s):

Mechanical Ventilation ◽

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Mechanical Prophylaxis ◽

Vein Thrombosis ◽

Icu Length Of Stay ◽

History Of ◽

Deep Vein ◽

Chemical Prophylaxis

Introduction: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. Methods: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Results: Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence ( P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis ( P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay ( P = .35) or mortality ( P = .34). Conclusions: Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

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Abstract TMP74: Stroke And Pulmonary Embolism, Clinical Features, Risk Factors And Outcome

Stroke ◽

10.1161/str.44.suppl_1.atmp74 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

jitphapa pongmoragot ◽

Alejandro Rabinstein ◽

Yongchai Nilanont ◽

Daniel Selchen ◽

Rick Swartz ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Length Of Stay ◽

Predisposing Factors ◽

P Value ◽

Stroke Patients ◽

Vein Thrombosis ◽

History Of ◽

Deep Vein

Introduction: Pulmonary embolism (PE) is an uncommon medical complication after stroke. Predisposing factors include deep vein thrombosis (DVT) in patients with hemiplegia or an underlying hypercoagulable state. However, little information is known regarding PE in stroke patients. Objective: We evaluated clinical characteristics, predisposing factors, and outcomes in stroke patients who developed PE. Methods: We included patients with an acute ischemic stroke (AIS) admitted to the participating institutions in the Registry of the Canadian Stroke Network between 2003 to 2008. Pulmonary embolism was diagnosed by nuclear imaging within 30 days of the stroke case index. Demographic data and clinical variables were collected. Logistic regression and survival analyses were completed to determine the association of risk factors with the outcomes of interest. Outcome Measures: primary outcome was death or disability at discharge defined as the modified Rankin scale >3. Secondary outcomes include admission to the Intensive Care Unit, disposition, and length of hospital stay, death at 3 months and at 1 year. Results: Among 11,287 patients with AIS, PE was found in 89 (0.78%) of patients. The development of PE was associated with higher risk of death in 30 days (25.8%vs 13.6%;p <0.001) and 1 year, (47.2% vs 24.6%;p <0.001). Disability was also more common in stroke patients with PE (85.4% vs 63.6% without PE; p <0.001). Mean length of stay was longer in stroke patients with PE (36 vs 16 days; p<0.001). Past medical history of cancer or deep vein thrombosis, history of cardiac arrest or deep vein thrombosis during admission were associated with PE. After adjustment, PE was associated with lower survival at 30 days (p value = 0.0012) and 1 year (p value < 0.0001) (Figures 1 & 2 represent survival function). Conclusions: In this large study, PE occurs in approximately 1% of AIS patients. PE was associated with higher disability, longer length of stay and lower short and long-term survival.

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Risk Factors Associated With Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients With Peripherally Inserted Central Venous Catheters

Journal of Infusion Nursing ◽

10.1097/nan.0000000000000037 ◽

2014 ◽

Vol 37 (3) ◽

pp. 187-196 ◽

Cited By ~ 14

Author(s):

Bonnie J. Clemence ◽

Rhonda E. Maneval

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Catheters ◽

Central Venous ◽

Factors Associated ◽

Vein Thrombosis ◽

Deep Vein

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Management of Recurrent Deep Vein Thrombosis in a Transgender Woman

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1611 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A792-A792

Author(s):

Seda Hanife Oguz ◽

Yahya Buyukasik ◽

Bulent O Yildiz

Keyword(s):

Deep Vein Thrombosis ◽

Family History ◽

Hormone Treatment ◽

Predisposing Factors ◽

Cerebrovascular Event ◽

Estradiol Treatment ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

History Of ◽

Deep Vein

Abstract Background: Transgender people using hormone treatment require lifelong medical care. Although cross-sex hormone treatment (CSHT) is usually considered safe, serious adverse events may occur. Here we report a case of deep vein thrombosis associated with estradiol treatment in an otherwise healthy young transgender woman. Case Presentation: A 21-year-old transgender woman using CSHT applied to our outpatient clinic with the complaint of painful swelling in her left leg. She was diagnosed with deep vein thrombosis (DVT) in the same leg one year earlier when she was admitted to the emergency room of another hospital with similar symptoms, and was given warfarin treatment for 3 months which has improved the symptoms. Three months after cessation of warfarin, symptoms re-occurred, but she was only able to apply to our clinic after another 3 months due to COVID-19 pandemic. Physical examination was unremarkable except asymmetrical swelling in the left leg. She has been receiving oral estradiol 6 mg/day and spironolactone 200 mg/day for 2 years. She denied taking estradiol in higher doses than recommended. She did not have any predisposing factors for DVT including obesity, immobilization and smoking. She had no prior history of venous thromboembolic events (VTE). Family history was also negative for thrombophilia except her uncle was diagnosed with ischemic cerebrovascular event at the age of 60. Lower extremity venous doppler ultrasonography revealed a thrombus in the left popliteal vein that caused total obstruction of blood flow to the distal. Plasma levels of d-dimer and fibrinogen were 0.35 mg/L and 262 mg/dL, respectively. Serum levels of sex hormones were estradiol: 204 pg/mL, total testosterone: 22.4 ng/dL, FSH: 0.22 mIU/mL, LH: 1.5 mIU/mL. Thrombophilia panel revealed a homozygous mutation in MTHFR (1296), and heterozygous mutations in both Factor V Leiden and plasma activator inhibitor (4G/5G). She was given enoxaparin in addition to warfarin until INR was elevated up to desired levels. Oral estradiol treatment was switched to transdermal route. Life-long anticoagulant treatment was suggested since the thrombotic event was triggered by estradiol treatment which will be continued. Conclusions: Limited data are available on incidence and management of VTE associated with estradiol treatment in male-to-female individuals. As in general population, routine screening for thrombophilia is not recommended in transgender women prior to the initiation of CSHT if no personal or family history of VTE is present. Even in the absence of predisposing factors, life-long anticoagulant therapy may be considered since the VTE-provoking estradiol treatment will be continued. Switching the route of estradiol treatment from oral to transdermal may be beneficial.

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