Incidence, risk factors, and outcomes of central venous catheter‐related thromboembolism in breast cancer patients: the CAVECCAS study

Abstract

Previous epidemiologic studies investigating central venous catheter (CVC)‐related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)‐CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double‐blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow‐up. Symptomatic DUS‐CRT were treated by anticoagulants. D‐Dimers, thrombin generation, and platelet‐derived microparticles were measured before and 2 days after CVC placement. In DUS‐CRT patients, a nested case–control study analyzed the role of thrombophilia. Among 524 patients, the DUS‐CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient‐months). Ten/14 symptomatic DUS‐CRT were detected on double‐blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS‐CRT. Age >50 years (OR, 1.80; 95% CI, 1.01–3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46–4.76) and comorbidities (OR, 2.05; 95% CI, 1.18–3.56) were associated with DUS‐CRT. No biomarkers was found to predict DUS‐CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46–4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32–4.96) remained the only significant DUS‐CRT risk factors. Thrombophilia did not account for DUS‐CRT. Only clinical parameters identified high risk DUS‐CRT patients who may be considered for thromboprophylaxis.

Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta‐analysis

“…57,96,97 Thromboembolic complications have become a major long-term problem of TIVAP use and the rate of catheter-related thrombosis varies considerably between researches and patient type. Base case 7,8,19,20,24,25,30,31,33,34,36,38,39,41,42,45,48,50- Prospective studies only 8,24,34,36,48,51,53,68,71,74,91,92 2.37 (1.34-3.40)…”

“…Twenty-one 7,8,20,22,25,36,39,41,42,48,55,61,64,68,69,71,75,76,92,94,95 of the 69 noncomparison studies (23 cohorts, n = 12 265) reported VTE by number of thrombosis per 1000 catheter-days. Within these studies, the pooled rate of VTE was 0.08 (95% CI: 0.06-0.10) per 1000 catheter-days ( Figure S2).…”

“…7,8,19,22,30,33,36,48,49,54,59,79,[91][92][93] Five studies were retrospective 8,37,49,50,55 and 10 were prospective. 7,19,22,30,33,59,79,[91][92][93] The incidence of PE in these studies was low at 0.9% (90 of 10 387) from a patient perspective. However, of the 450 total VTE events developed in these studies, PE represented 20% of all thromboembolisms.…”

“…2001-2009 [50][51][52][53][54]56,57,59,61,64,92 Material of catheter Silicone 7,24,25,36,48,56,57,59,69,71,74,76,79 2.…”

Diagnosis and Treatment of Arterial Occlusion after Knee Arthroplasty: The Sooner, the Better

“…Interestingly, we also found that there were 4 patients who had a history of cancer, 2 for prostatic cancer and 2 for breast cancer (Table ). The cancer history might lead to a hypercoagulable state so that thrombosis is formed more easily than in others. Therefore, these people should be considered as having high risk of arterial occlusion after knee arthroplasty.…”