Prevention of catheter‐related venous thrombosis with nadroparin in patients receiving chemotherapy for hematologic malignancies: a randomized, placebo‐controlled study

Abstract

To cite this article: Niers TMH, Di Nisio M, Klerk CPW, Baarslag HJ, Bü ller HR, Biemond BJ. Prevention of catheter-related venous thrombosis with nadroparin in patients receiving chemotherapy for hematologic malignancies: a randomized, placebo-controlled study. J Thromb Haemost 2007; 5: 1878-82.Summary. Background: Hemato-oncology patients treated with intensive chemotherapy usually require the placement of a central venous catheter (CVC). CVCs are frequently complicated by catheter-related central venous thrombosis (CVT), which has been associated with an increased risk of pulmonary embolism and catheter-related infection. Objectives: To determine the efficacy and safety of thromboprophylaxis with s.c. low-molecular-weight heparin (nadroparin) administered once daily in a randomized placebo-controlled, double-blind trial in patients with hematologic malignancies. Patients and methods: Consecutive patients with hematologic malignancies requiring intensive chemotherapy including autologous stem cell transplantation were eligible. The patients were randomized to receive nadroparin 2850 antifactor Xa units once daily or placebo s.c. for 3 weeks. Venography was performed on day 21 after CVC insertion. Secondary outcomes were bleeding and catheter-related infection. Results: In total, 113 patients were randomized to nadroparin or placebo, and 87 patients (77%) underwent venography. In total, 11 venographically proven catheter-related CVTs were diagnosed. The frequency of catheter-related CVT was not significantly different between study groups, namely four catheter-related CVTs in the placebo group [9%; 95% CI: 0.002-0.16] vs. seven catheter-related CVTs in the nadroparin group (17%; 95% CI: 0.06-0.28). In addition, no difference in the incidence of catheterrelated infection or bleeding was observed between the groups. Conclusion: This study showed that the actual risk for catheter-related CVT in patients with hematologic malignancies is lower than suggested in earlier studies in cancer patients. Although prophylactic administration of nadroparin appeared to be safe in this group of patients with a high risk of bleeding, it cannot be recommended for the prevention of catheter-related CVT or catheter-related infection in patients with hematologic malignancies.

The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention

“…Although 3 recent randomized, controlled trials demonstrated LMWH and low-dose warfarin to be well tolerated in cancer patients with indwelling catheters, neither approach led to a decrease in catheter-associated thrombosis. [35][36][37] As a retrospective analysis, this study has a number of limitations. First, VTE prophylaxis, in the form of encouraged ambulation, was not standardized or quantified in the medical record.…”

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

“…The incidence of CRT varies considerably among studies, and has dramatically decreased over time. Earlier studies published in the 1980s and 1990s reported rates as high as 66%, but more recent trials have shown that only 14-18% of patients with cancer and a central venous catheter have evidence of CRT when screening venography or ultrasonography is performed [6,[10][11][12]. Symptomatic CRT occurs much less frequently, at a rate of 5% or lower in prospective cohort studies [13][14][15].…”

“…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].…”

Use of port-a-cath in cancer patients: a single-center experience

“…At our institution, we observe guidelines for the management of port-a-caths [21,22]; however, prophylactic low-dose anticoagulation is not used routinely. The use of prophylactic anti-coagulation has been studied extensively in the literature; though two studies demonstrated benefits with mini doses of warfarin, later larger trials showed contradictory results [23][24][25][26]. Similarly, only one study showed better results with the use of low molecular weight heparin (LMWH) in a patient with TIVAP, but subsequent studies were negative [25].…”

“…The use of prophylactic anti-coagulation has been studied extensively in the literature; though two studies demonstrated benefits with mini doses of warfarin, later larger trials showed contradictory results [23][24][25][26]. Similarly, only one study showed better results with the use of low molecular weight heparin (LMWH) in a patient with TIVAP, but subsequent studies were negative [25]. Currently, there are no recommendations for the prophylactic use of anticoagulation therapy for patients with a port-a-cath in place.…”