Central venous catheter–related thrombosis

Abstract

Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs. Learning Objectives• To identify the types and consequences of catheter-related thrombotic complications in patients with CVCs • To develop an approach to the management of CVC-related thrombosis • To review the evidence on the prevention of CVC-related thrombosis

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…41 CRT can lead to significant discomfort from symptoms, catheter dysfunction, increased risk for infections and long-term risk for venous stenosis. 41 Although CRT clearly contributes to morbidity and catheter dysfunction, the majority of CRT are asymptomatic and there is little evidence that CRT is associated with an increased rate of pulmonary embolism or increased mortality. 42 The primary objectives of treatment of CRT are to reduce symptoms, prevent extension into more central veins, preserve access and to prevent chronic venous stenosis.…”

“…48 Several clinicians prefer to continue anticoagulation for 1-2 weeks after the catheter is removed. 41 …”

“…Incidence of symptomatic CRT ranges from 4 to 14% in different studies. 41 Despite multiple randomized and observational studies, thromboprophylaxis for the prevention of CRT in patients with cancer remains controversial. A randomized control trial of enoxaparin 40 mg SC daily for 6 weeks vs placebo daily for 6 weeks in patients with cancer undergoing CVC insertion found that enoxaparin was safe, but did not reduce the rate of CVC-related thrombosis.…”

“…[66][67][68] Based on the available evidence, prophylactic anticoagulation to prevent CRT is not routinely recommended. 41 VTE TREATMENT Venous duplex ultrasonography should be performed in patients presenting with extremity swelling, redness or tenderness; or pulmonary angiography in patients with chest pain, dyspnea or unexplained tachycardia. A clinical assessment of bleeding risk is …”

How I treat central venous access device–related upper extremity deep vein thrombosis

“…Although flushing or locking catheters with heparin or saline has been standard practice for years, data demonstrating the effectiveness of these practices is lacking. 28 Anticoagulant thromboprophylaxis to prevent CRT has been the subject of multiple clinical trials (Table 2). [30][31][32][33][34][35][36][37][38][39][40][41][42] Early studies suggested that fixed low-dose warfarin (1 mg/d) or LMWH (dalteparin: 2500 U/d) was associated with reduced rates of CRT in cancer patients.…”