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

Abstract

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.

Cisplatin-Based Chemotherapy for Testicular Germ Cell Tumors: Complication Rates of Peripheral versus Central Venous Administration

“…Symptomatic catheter-related deep vein thrombosis is reported in about 5% of oncologic patients [26]. Referring to patient-based data, these results are comparable to our own study results (1.0%).…”

Selective depletion of factor XI or factor XII with antisense oligonucleotides attenuates catheter thrombosis in rabbits

“…4 Symptomatic thrombosis occurs in at least 5% of cancer patients with CVCs and is a serious problem because it often delays cancer treatment, prolongs hospital stay, and increases health care costs by necessitating anticoagulant therapy in patients at risk for bleeding. 4 The pathogenesis of thrombosis in patients with CVCs is unclear. Low doses of warfarin and prophylactic low-molecular-weight heparin do not reduce the risk of CVC-associated thrombosis.…”

Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: A nested case–control study

“…Furthermore, in contrast to existing evidence [17], we found that in-hospital administration of pharmacological VTE-prophylaxis trended towards preventing PICC-DVT. As the majority of available data regarding catheter-DVT comes from patients with cancer [26][27][28] who often receive non-PICC devices [29,30], our findings regarding antiplatelet agents and effects of VTE prophylaxis may relate to important differences in study population and device characteristics. Given the existence of other supportive data regarding the influence of VTE prophylaxis on PICC-DVT [31][32][33] and a potentially protective role of statins on thrombosis [34], further, controlled studies of VTE prophylaxis, antiplatelet treatment and statins to prevent PICC-DVT appear warranted.…”