Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy

Abstract

The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention.

Epidemiology and natural history of central venous access device use and infusion pump function in the NO16966 trial

“…However, in the NO16966 study, we observed lower or comparable rates of thrombosis compared with 1–18% in several other studies involving CVADs (where patients did not receive prophylaxis against thrombosis) (Verso et al , 2005; Karthaus et al , 2006; Fagnani et al , 2007; Ng et al , 2007; Araújo et al , 2008; Surov et al , 2008; Biffi et al , 2009; Starling et al , 2009; Beckers et al , 2010; Cavanna et al , 2010; Barbetakis et al , 2011; Kriegel et al , 2011; Saber et al , 2011). We also observed lower or comparable rates of infection than the 2.4–58.3% previously reported rates (Karthaus et al , 2006; Fagnani et al , 2007; Ng et al , 2007; Beckers et al , 2010; Cavanna et al , 2010; Barbetakis et al , 2011), although even lower infection rates of 0.4–2.5% have also been reported in some studies (Araújo et al , 2008; Biffi et al , 2009).…”

Antiangiogeneic Strategies in Mesothelioma

“…Bevacizumab is also associated with impaired wound healing (45), likely due to the critical role of VEGF in this process. Whilst the half-life of plasma bevacizumab is 20 days, its tissue half-life is 6 weeks, hence a minimum of 28 days (preferably 6-8 weeks) should elapse between major surgery and the previous dose of bevacizumab (46).…”

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

“…After exclusion of 131 ineligible reports, we included 80 articles in the meta‐analysis (Figure 1). 7‐10,19‐93 Sixty‐nine studies with 86 cohorts included 37 000 patients who underwent TIVAP implantation without a comparison arm, 7‐10,19‐79,91‐93 whereas 11 studies (n = 2148) compared TIVAPs with external CVCs (mainly Hickman and PICC catheters) (Tables 1 and 2). 80‐90 For noncomparison studies, only two studies explicitly reported the use of anticoagulant prophylaxis (warfarin 1 mg orally daily) for VTE, 62,67 12 reported no use of any anticoagulant prophylaxis,…”

“…[80][81][82][83][84][85][86][87][88][89][90] For noncomparison studies, only two studies explicitly reported the use of anticoagulant prophylaxis (warfarin 1 mg orally daily) for VTE, 62,67 12 reported no use of any anticoagulant prophylaxis, 8,19,33,41,48,53,61,67,70,[91][92][93] and 1 used warfarin (1 mg/d) in less than 50% of their population, 64 whereas the other 54 studies did not report data for this treatment. Twenty-one studies reported the median time to occurrence of symptomatic catheter-related VTE, 8,[19][20][21]30,33,39,41,43,50,61,62,64,67,69,70,[76][77][78][79]91 which ranged from 4 to 205 days. We used the Newcastle-Ottawa scale to assess both comparison and noncomparison studies for s...…”