Thrombotic Complications of Central Venous Catheters in Cancer Patients

Abstract

Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

Vascular Access in Oncology Patients

“…77 To address this issue, the Italian Study Group for Long Term Central Venous Access promoted a nationwide consensus on catheter-related central venous thrombosis. 78 The problem of thrombosis is particularly relevant because the incidence of venous thromboembolism is markedly higher in patients with cancer than in patients without cancer, 79 as thrombosis is a direct consequence of tumor growth and host inflammatory responses and an indirect consequence of cancer treatment, venous stasis, and direct vessel trauma.…”

Persistencia intracardíaca de la vaina de fibrina pericatéter en un neonato: informe de un caso

“…Considerando que la vaina de fibrina es un tipo de trombo asociado con el CVC, 10 en los neonatos las guías sugieren, ya sea anticoagulación inicial o cuidado de soporte con vigilancia radiológica para detectar el crecimiento del trombo; si ocurriera esto último, entonces indicar anticoagulación; no recomiendan la terapia trombolítica, excepto que la obstrucción venosa cause un compromiso crítico de órganos o de extremidades; si se requiere trombólisis, sugieren administrar activador tisular del plasminógeno (tPA) con infusión previa de plasma fresco congelado (nivel de evidencia…”

Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoéticas

“…Grampositive bacteria figure among the most frequent isolated causes of these complications, particularly Staphylococcus strains, which are microorganisms from the patient's endogenous microbiota (13,(18)(19) . Another interesting data is that more than 80% of infections in immunocompromised patients are attributed to microbiota colonizing the patient him/herself (18) .…”