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

Cicco, Marcello De; Matovic, Mira; Balestreri, Luca; Steffan, Agostino; Pacenzia, R.; Malafronte, M.; Fantin, D.; Bertuzzi, C. A.; Fabiani, F; Morassut, Sandro; Bidoli, Ettore; Veronesi, Andrea

doi:10.1093/annonc/mdp235

Cited by 48 publications

(59 citation statements)

References 25 publications

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“…5 Contrast venography in 114 patients 1 week after placement of a CVC detected DVT in 53%, but only 3% were occlusive. 6 Over the past 2 decades, although the use of CVCs has increased dramatically, the risk of CRTs per catheter has decreased, perhaps related to less thrombogenic catheters and improved insertion techniques. 7,8 Although the majority of asymptomatic CRT cases remain subclinical, symptomatic DVT occurs in 1%-5% of patients with a CVC (Table 1).…”

Section: Incidence Of Crtmentioning

confidence: 99%

Central venous catheter–related thrombosis

2014

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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

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Section: Incidence Of Crtmentioning

confidence: 99%

Central venous catheter–related thrombosis

2014

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“…Fixeddose warfarin did not reduce the incidence of symptomatic radiographically confirmed catheter-associated thrombosis compared with no treatment (7% vs. 6%; P = 0.98), but dose-adjusted warfarin did significantly reduce the incidence of symptomatic catheter-associated thrombosis (2.7% vs. 7.2%; RR, 0.38; P = 0.002) at the expense of increased major bleeding complications (3.4% vs. 1.5%; P = 0.04). Although one early study suggested efficacy with fixed-dose warfarin [16], other randomized trials [16][17][18] and meta-analyses [19,20] have failed to show a significant reduction in the incidence of symptomatic catheter-associated thrombosis with warfarin prophylaxis.…”

Section: Pharmacologic Prevention Of Catheter-associated Thrombosis Imentioning

confidence: 99%

“…Similarly, several randomized studies explored the efficacy of prophylactic-dose low-molecular-weight heparin [17,21,22]. In one trial, 385 cancer patients were randomized to enoxaparin (40 mg daily) or placebo, and venography was performed 6 weeks later to determine the primary endpoint of asymptomatic upper extremity DVT [22].…”

Section: Pharmacologic Prevention Of Catheter-associated Thrombosis Imentioning

confidence: 99%

Catheter‐associated deep vein thrombosis of the upper extremity in cancer patients: guidance from the SSC of the ISTH

Zwicker

Connolly

Carrier

et al. 2014

Journal of Thrombosis and Haemostasis

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“…The efficacy and safety of using anticoagulant prophylaxis to prevent CRT have been investigated in a number of randomized trials (Table 3) [10][11][12][38][39][40][41][42][43][44][45]. The earliest studies suggested that low-dose warfarin (1 mg daily) or LMWH at a standard postoperative prophylaxis dose could significantly reduce the incidence of CRT in cancer patients [38,43].…”

Section: Prevention Of Crtmentioning

confidence: 99%

Epidemiology and prevention of catheter‐related thrombosis in patients with cancer

Lee

Kamphuisen

2012

Journal of Thrombosis and Haemostasis

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Summary. Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter‐related thrombosis (CRT). Contemporary studies have shown that the incidence of symptomatic CRT is ∼ 5%, whereas the incidence of asymptomatic CRT is higher, at 14–18%. The significance and mechanisms of catheter design, material, insertion location and technique, position of the catheter tip and other risk factors in contributing to the development of CRT are not well understood. Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin‐bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome.

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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

Abstract: In this study of early and short-term prophylaxis, acenocumarine was more effective than dalteparin on non-occlusive and asymptomatic CVCrT events. The first days following CVC insertion represent the highest risk for CVCrT.

Cited by 48 publications

References 25 publications

Central venous catheter–related thrombosis

Central venous catheter–related thrombosis

Catheter‐associated deep vein thrombosis of the upper extremity in cancer patients: guidance from the SSC of the ISTH

Epidemiology and prevention of catheter‐related thrombosis in patients with cancer

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