Prevention of Central Venous Catheter-Associated Thrombosis: A Meta-analysis

Kirkpatrick, Angelia; Rathbun, Suman; Whitsett, Thomas L.; Raskob, Gary E.

doi:10.1016/j.amjmed.2007.05.010

Cited by 63 publications

(48 citation statements)

References 69 publications

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“…Several meta-analyses have summarized the results of published studies on the efficacy and safety of anticoagulant prophylaxis in preventing CRT in cancer patients [47][48][49][50][51][52]. The most recent Cochrane Systematic Review, published in 2011, included 12 studies enrolling 36 111 patients with cancer [52].…”

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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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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“…40 The authors found that all prophylactic strategies significantly reduced the risk of all (symptomatic and asymptomatic) catheter-associated DVT, with summary relative risks ranging from 0.31 (95% CI, 0.13 to 0.71) for low-dose, unfractionated, heparin infusions; 0.37 (95% CI 0.26 to 0.52) for low-dose, vitamin-K antagonists; and 0.72 (95% CI 0.57 to 0.90) for subcutaneous low-molecular-weight heparin, without significantly increasing the risk of major bleeding. While all strategies provided effective prophylaxis against all (symptomatic and asymptomatic) catheter-associated DVT, individually, and against the risk of symptomatic DVT, collectively, no single strategy decreased the risk for development of symptomatic DVT.…”

Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

“…Moreover, amidst few events and trials reporting outcomes such as PE and mortality, the authors did not detect significant reductions in PE or death with anticoagulant prophylaxis. 40 Treatment of RHTE and PE While RHTE are associated with PE and increased mortality, their management has not been well delineated. At present, the seventh American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy does not address the treatment of CVC-related PE and RHTE.…”

Section: Prevention Of Cvc Associated Thrombosismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

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“…8,23,[39][40][41] A meta-analysis of 15 randomized trials comparing anticoagulant thromboprophylaxis to no prophylaxis in 1714 patients with CVC found a significant benefit of anticoagulant prophylaxis both for asymptomatic (13.5% vs 27.4%, P Ͻ .0001) and symptomatic CRT (3.1% vs 5.4%, P ϭ .04). 40 However, a more recent systematic review, restricted to CVC in 3611 cancer patients, found that both prophylactic heparin and low dose vitamin K antagonist showed only a nonsignificant trend toward a decrease in symptomatic DVT. 8 The largest study of thromboprophylaxis in CVC randomized 1590 cancer patients undergoing chemotherapy to adjusted-dose warfarin (international normalized ratio, 1.5-2.0), fixed-dose warfarin (1 mg/d), and no prophylaxis.…”

Section: Management Of Thrombotic Occlusion Of a Cvcmentioning

confidence: 99%

“…[37][38][39] Prevention of CRT Multiple reviews of strategies to try to prevent CRT are available. 1,8,23,35,[39][40][41] There is evidence that selecting the smallest catheter for the purpose and placement of the catheter tip in the SVC just above the right atrium reduces the risk of CRT. 16,17,23 Flushing CVCs with heparinized saline has not been shown to reduce line occlusion, CRT or catheter-related infections compared with saline flushing or no flushing.…”

Section: Management Of Thrombotic Occlusion Of a Cvcmentioning

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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Prevention of Central Venous Catheter-Associated Thrombosis: A Meta-analysis

Cited by 63 publications

References 69 publications

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

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

A critical review of thromboembolic complications associated with central venous catheters

Central venous catheter–related thrombosis

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