Risk Factors for Upper Limb Deep Vein Thrombosis Associated with the Use of Central Vein Catheter in Cancer Patients

Overview

Journal Intern Emerg Med

Publisher Springer

Specialties Emergency Medicine
General Medicine

Date 2008 Mar 5

PMID 18317868

Citations 29

Authors

Melina Verso

Giancarlo Agnelli

Pieter W Kamphuisen

Walter Ageno

Mario Bazzan

Antonio Lazzaro

Francesco Paoletti

Maurizio Paciaroni

Stefano Mosca

Sergio Bertoglio

Affiliations

Soon will be listed here.

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.

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References

Timsit J, Farkas J, Boyer J, Martin J, Misset B, Renaud B . Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest. 1998; 114(1):207-13. DOI: 10.1378/chest.114.1.207. View

Luciani A, Clement O, Halimi P, Goudot D, Portier F, Bassot V . Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology. 2001; 220(3):655-60. DOI: 10.1148/radiol.2203001181. View

Agnelli G, Verso M . Therapy Insight: venous-catheter-related thrombosis in cancer patients. Nat Clin Pract Oncol. 2006; 3(4):214-22. DOI: 10.1038/ncponc0458. View

De Cicco M, Matovic M, Balestreri L, Panarello G, Fantin D, Morassut S . Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res. 1997; 86(2):101-13. DOI: 10.1016/s0049-3848(97)00054-6. View

Geerts W, Pineo G, Heit J, Bergqvist D, Lassen M, Colwell C . Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126(3 Suppl):338S-400S. DOI: 10.1378/chest.126.3_suppl.338S. View

Verso M, Agnelli G, Bertoglio S, Di Somma F, Paoletti F, Ageno W . Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients. J Clin Oncol. 2005; 23(18):4057-62. DOI: 10.1200/JCO.2005.06.084. View

Agnelli G, Verso M . Is antithrombotic prophylaxis required in cancer patients with central venous catheters? No. J Thromb Haemost. 2006; 4(1):14-5. DOI: 10.1111/j.1538-7836.2005.01734.x. View

Unal A, Bayar S, Arat M, Ilhan O . Malpositioning of Hickman catheters, left versus right sided attempts. Transfus Apher Sci. 2003; 28(1):9-12. DOI: 10.1016/S1473-0502(02)00094-0. View

Stephens L, Haire W, Tarantolo S, Reed E, Kessinger A, Klein R . Normal saline versus heparin flush for maintaining central venous catheter patency during apheresis collection of peripheral blood stem cells (PBSC). Transfus Sci. 1997; 18(2):187-93. DOI: 10.1016/s0955-3886(97)00008-8. View

10.

Karthaus M, Kretzschmar A, Kroning H, Biakhov M, Irwin D, Marschner N . Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial. Ann Oncol. 2005; 17(2):289-96. DOI: 10.1093/annonc/mdj059. View

11.

Blom J, Doggen C, Osanto S, Rosendaal F . Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005; 293(6):715-22. DOI: 10.1001/jama.293.6.715. View

12.

Tesselaar M, Ouwerkerk J, Nooy M, Rosendaal F, Osanto S . Risk factors for catheter-related thrombosis in cancer patients. Eur J Cancer. 2004; 40(15):2253-9. DOI: 10.1016/j.ejca.2004.06.023. View

13.

Craft P, May J, Dorigo A, Hoy C, Plant A . Hickman catheters: left-sided insertion, male gender, and obesity are associated with an increased risk of complications. Aust N Z J Med. 1996; 26(1):33-9. DOI: 10.1111/j.1445-5994.1996.tb02904.x. View

14.

Kearns P, Coleman S, Wehner J . Complications of long arm-catheters: a randomized trial of central vs peripheral tip location. JPEN J Parenter Enteral Nutr. 1996; 20(1):20-4. DOI: 10.1177/014860719602000120. View

15.

Bern M, Lokich J, Wallach S, Bothe Jr A, Benotti P, Arkin C . Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med. 1990; 112(6):423-8. DOI: 10.7326/0003-4819-76-3-112-6-423. View

16.

Verso M, Agnelli G . Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003; 21(19):3665-75. DOI: 10.1200/JCO.2003.08.008. View

17.

Petersen J, DELANEY J, Brakstad M, Rowbotham R, Bagley Jr C . Silicone venous access devices positioned with their tips high in the superior vena cava are more likely to malfunction. Am J Surg. 1999; 178(1):38-41. DOI: 10.1016/s0002-9610(99)00124-5. View

18.

Gould J, Carloss H, Skinner W . Groshong catheter-associated subclavian venous thrombosis. Am J Med. 1993; 95(4):419-23. DOI: 10.1016/0002-9343(93)90312-d. View

19.

Agnelli G, Verso M . Thrombosis and cancer: clinical relevance of a dangerous liaison. Haematologica. 2005; 90(2):154-6. View

20.

Monreal M, Alastrue A, Rull M, Mira X, Muxart J, Rosell R . Upper extremity deep venous thrombosis in cancer patients with venous access devices--prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost. 1996; 75(2):251-3. View