Semin Thromb Hemost 2007; 33(4): 389-396
DOI: 10.1055/s-2007-976174
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Thromboembolic Complications Related to Central Venous Access Catheters in Cancer Patients

César O. Freytes1
  • 1Audie L. Murphy Memorial Veterans Hospital and University of Texas Health Science Center at San Antonio, San Antonio, Texas
Further Information

Publication History

Publication Date:
24 May 2007 (online)

ABSTRACT

Recent well-designed, prospective, controlled trials have demonstrated a lower incidence of catheter-related deep vein thrombosis (CRDVT) compared with earlier studies but this complication remains an important limitation to the delivery of drugs and supportive care to cancer patients. Prophylaxis of CRDVT with antithrombotic agents was not supported by recent prospective randomized trials, and its routine use is not recommended. Larger studies will be required to determine if cancer patients at particularly high risk for CRDVT can benefit from prophylaxis with antithrombotic agents. There are no prospective controlled studies to guide the therapy of CRDVT but treatment with anticoagulants remains the mainstay of therapy. Although recently published guidelines might help standardize the therapy of patients with CRDVT, prospective controlled studies are needed to determine the optimal therapy of this important complication of central venous catheters in cancer patients.

REFERENCES

  • 1 Hoshal Jr V L, Ause R G, Hoskins P A. Fibrin sleeve formation of indwelling subclavian central venous catheters.  Arch Surg. 1971;  102 253-258
  • 2 Balestreri L, De Cicco M, Matovic M et al.. Central venous catheter-related thrombosis in clinically asymptomatic oncologic patients: a phlebographic study.  Eur J Radiol. 1995;  20 108-111
  • 3 De Cicco M, Matovic M, Balestreri L et al.. Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study.  Thromb Res. 1997;  86 101-113
  • 4 Xiang D Z, Verbeken E K, van Lommel A T et al.. Composition and formation of the sleeve enveloping a central venous catheter.  J Vasc Surg. 1998;  28 260-271
  • 5 Forauer A R, Theoharis C G, Dasika N L. Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model.  Radiology. 2006;  240 427-434
  • 6 Starkhammar H, Bengtsson M, Morales O. Fibrin sleeve formation after long-term brachial catheterization, with implantable port device. A prospective venographic study.  Eur J Surg. 1992;  158 481-484
  • 7 Raad I I, Luna M, Khalil S A et al.. The relationship between the thrombotic and infectious complications of central venous catheters.  JAMA. 1994;  271 1014-1016
  • 8 Hurtubise M R, Bottino J C, Lawson M et al.. Restoring patency of occluded central venous catheters.  Arch Surg. 1980;  115 212-213
  • 9 Hooke C. Recombinant tissue plasminogen activator for central venous access device occlusion.  J Pediatr Oncol Nurs. 2000;  17 174-178
  • 10 Stephens L C, Haire W D, Kotulak G D. Are clinical signs accurate indicators of the cause of central venous catheter occlusion?.  JPEN J Parenter Enteral Nutr. 1995;  19 75-79
  • 11 Schifferdecker B, Shaw J A, Piemonte T C, Eisenhauer A C. Nonmalignant superior vena cava syndrome. Pathophysiology and management.  Catheter Cardiovasc Interv. 2005;  65 416-442
  • 12 Monreal M, Lafoz E, Ruiz J et al.. Upper extremity deep venous thrombosis and pulmonary embolism. A prospective study.  Chest. 1991;  99 280-283
  • 13 Prandoni P, Bernardi E, Marchiori A et al.. The long-term clinical course of acute deep vein thrombosis of the arm: prospective cohort study.  BMJ. 2004;  329 484-485
  • 14 Bernardi E, Pesavento R, Prandoni P. Upper extremity deep vein thrombosis.  Semin Thromb Hemost. 2006;  32 729-736
  • 15 Agnelli G, Verso M. Therapy insight: venous-catheter-related thrombosis in cancer patients.  Nat Clin Pract Oncol. 2006;  3 214-222
  • 16 Bozzetti F, Scarpa D, Terno G J et al.. Subclavian venous thrombosis due to indwelling catheters: a prospective study on 52 patients.  JPEN J Parenter Enteral Nutr. 1983;  7 560-562
  • 17 Lokich J J, Becker B. Subclavian vein thrombosis in patients treated with infusion chemotherapy for advanced malignancy.  Cancer. 1983;  52 1586-1589
  • 18 Bern M M, Lokich J J, Wallach S R et al.. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.  Ann Intern Med. 1990;  112 423-428
  • 19 Monreal M, Alastrue A, Rull M et al.. Upper extremity deep venous thrombosis in cancer patients with venous access devices-prophylaxis with a low molecular weight heparin (Fragmin).  Thromb Haemost. 1996;  75 251-253
  • 20 Horne III M K, May D J, Alexander H R et al.. Venographic surveillance of tunneled venous access devices in adult oncology patients.  Ann Surg Oncol. 1995;  2 174-178
  • 21 Barzaghi A, Dell'Orto M, Rovelli A et al.. Central venous catheter clots: incidence, clinical significance and catheter care in patients with hematologic malignancies.  Pediatr Hematol Oncol. 1995;  12 243-250
  • 22 Glaser D W, Medeiros D, Rollins N, Buchanan G R. Catheter-related thrombosis in children with cancer.  J Pediatr. 2001;  138 255-259
  • 23 Haire W D, Lieberman R P, Edney J et al.. Hickman catheter-induced thoracic vein thrombosis. Frequency and long-term sequelae in patients receiving high-dose chemotherapy and marrow transplantation.  Cancer. 1990;  66 900-908
  • 24 Kuter D J. Thrombotic complications of central venous catheters in cancer patients.  Oncologist. 2004;  9 207-216
  • 25 Couban S, Goodyear M, Burnell M et al.. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer.  J Clin Oncol. 2005;  23 4063-4069
  • 26 Lee A Y, Levine M N, Butler G et al.. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer.  J Clin Oncol. 2006;  24 1404-1408
  • 27 Biffi R, De Braud F, Orsi F et al.. A randomized, prospective trial of central venous ports connected to standard open-ended or Groshong catheters in adult oncology patients.  Cancer. 2001;  92 1204-1212
  • 28 Verso M, Agnelli G, Bertoglio S et al.. Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo controlled, randomized study in cancer patients.  J Clin Oncol. 2005;  23 4057-4062
  • 29 Karthaus M, Kretzchmar A, Kroning A et al.. Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial.  Ann Oncol. 2006;  17 289-296
  • 30 Levine M, Kakkar A K. Catheter-associated thrombosis: thromboprophylaxis or not?.  J Clin Oncol. 2005;  23 4006-4008
  • 31 Prandoni P, Polistena P, Bernardi E et al.. Upper extremity deep vein thrombosis. Risk factors, diagnosis and complications.  Arch Intern Med. 1997;  157 57-62
  • 32 Koksoy C, Kuzu A, Kutlay J et al.. The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis.  Clin Radiol. 1995;  50 687-689
  • 33 Gaitini D, Beck-Razi N, Haim N, Brenner B. Prevalence of upper extremity deep venous thrombosis diagnosed by color duplex sonography in cancer patients with central venous catheters.  J Ultrasound Med. 2006;  25 1297-1303
  • 34 Male C, Chait P, Ginsberg J S et al.. Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body of children: results of the PARKAA study.  Thromb Haemost. 2002;  87 593-598
  • 35 Kroencke T J, Taupitz M, Arnold R, Fritsche L, Hamm B. Three-dimensional gadolinium-enhanced magnetic resonance venography in suspected thrombo-occlusive disease of the central chest veins.  Chest. 2001;  120 1570-1576
  • 36 Thornton M J, Ryan R, Varghese J C et al.. A three-dimensional gadolinium-enhanced MR venography technique for imaging central veins.  AJR Am J Roentgenol. 1999;  173 999-1003
  • 37 Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients.  J Clin Oncol. 2003;  21 3665-3675
  • 38 Adess M, Eisner R, Nand S et al.. Thromboembolism in cancer patients: pathogenesis and treatment.  Clin Appl Thromb Hemost. 2006;  12 254-266
  • 39 Fijnheer R, Paijmans B, Verdonck L F et al.. Factor V Leiden in central venous catheter-associated thrombosis.  Br J Haematol. 2002;  118 267-270
  • 40 Riordan M, Weiden P L. Factor V Leiden mutation does not account for central venous catheter-related thrombosis.  Am J Hematol. 1998;  58 150-152
  • 41 Mandala M, Curigliano G, Bucciarelli P et al.. Factor V Leiden and G20210A prothrombin mutation and the risk of subclavian vein thrombosis in patients with breast cancer and a central venous catheter.  Ann Oncol. 2004;  15 590-593
  • 42 Abdelkefi A, Ben Romdhane N, Kriaa A et al.. Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplant recipients.  Bone Marrow Transplant. 2005;  36 885-889
  • 43 Tesselaar M E, Ouwerkerk J, Nooy M A et al.. Risk factors for catheter-related thrombosis in cancer patients.  Eur J Cancer. 2004;  40 2253-2259
  • 44 Mandala M, Curigliano G, Bucciarelli P et al.. Factor V Leiden and G20210A prothrombin mutation and the risk of subclavian vein thrombosis in patients with breast cancer and a central venous catheter.  Ann Oncol. 2004;  15 590-593
  • 45 van Rooden C J, Rosendaal F R, Meinders A E et al.. The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis.  Haematologica. 2004;  89 201-206
  • 46 Wermes C, von Depka Prondzinski M, Lichtinghagen R et al.. Clinical relevance of genetic risk factors for thrombosis in paediatric oncology patients with central venous catheters.  Eur J Pediatr. 1999;  158(suppl 3) S43-146
  • 47 Eastman M E, Khorsand M, Maki D G et al.. Central venous device-related infection and thrombosis in patients treated with moderate dose continuous-infusion interleukin-2.  Cancer. 2001;  91 806-814
  • 48 Stephens L C, Haire W D, Schmit-Pokorny K, Kessinger A, Kotulac G. Granulocyte macrophage colony stimulating factor: high incidence of apheresis catheter thrombosis during peripheral stem cell collection.  Bone Marrow Transplant. 1993;  11 51-54
  • 49 Borow M, Crowley J G. Evaluation of central venous catheter thrombogenicity.  Acta Anaesthesiol Scand Suppl. 1985;  81 59-64
  • 50 Eastridge B J, Lefor A T. Complications of indwelling venous access devices in cancer patients.  J Clin Oncol. 1995;  13 233-238
  • 51 Brown-Smith J K, Stoner M H, Barley Z A. Tunneled catheter thrombosis: factors related to incidence.  Oncol Nurs Forum. 1990;  17 543-549
  • 52 Craft P S, May J, Dorigo A, Hoy C, Plant A. Hickman catheters: left sided insertion, male gender and obesity are associated with an increased risk of complications.  Aust N Z J Med. 1996;  26 33-39
  • 53 Male C, Chait P, Andrew M et al.. Central venous line-related thrombosis in children: association with central venous line location and insertion technique.  Blood. 2003;  101 4273-4278
  • 54 McBride K D, Fisher R, Warnock N et al.. A comparative analysis of radiological and surgical placement of central venous catheters.  Cardiovasc Intervent Radiol. 1997;  20 17-22
  • 55 van Rooden C J, Schippers E F, Barge R M et al.. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study.  J Clin Oncol. 2005;  23 2655-2660
  • 56 Journeycake J M, Buchanan G R. Catheter-related deep venous thrombosis and other complications in children with cancer.  J Clin Oncol. 2006;  24 4575-4580
  • 57 Trerotola S O, Kuhn-Fulton J, Johnson M S et al.. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access.  Radiology. 2000;  217 89-93
  • 58 MacDonald S, Watt A J, McNally D, Edwards R D, Moss J G. Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches.  J Vasc Interv Radiol. 2000;  11 225-231
  • 59 Nightingale C E, Norman A, Cunningham D et al.. A prospective analysis of 949 long-term central venous access catheters for ambulatory chemotherapy in patients with gastrointestinal malignancy.  Eur J Cancer. 1997;  33 398-403
  • 60 Bern M M, Lokich J J, Wallach S R et al.. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.  Ann Intern Med. 1990;  112 423-428
  • 61 Boraks P, Seale J, Price J et al.. Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with hematologic malignancies.  Br J Haematol. 1998;  101 483-486
  • 62 Heaton D C, Han D Y, Inder A. Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis.  Intern Med J. 2002;  32 84-88
  • 63 Mismetti P, Mille D, Laporte S et al.. Low-molecular-weight heparin (nadroparin) and very low doses of warfarin in the prevention of upper extremity thrombosis in cancer patients with indwelling long-term central venous catheters: a pilot randomized trial.  Haematologica. 2003;  88 67-73
  • 64 Agnelli G, Verso M. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? No.  J Thromb Haemost. 2006;  4 14-15
  • 65 Levine M. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? Still an open question.  J Thromb Haemost. 2006;  4 16-18
  • 66 Huisman M V. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? Yes for special patient groups.  J Thromb Haemost. 2006;  4 10-13
  • 67 Timoney J P, Malkin M G, Leone D M et al.. Safe and cost effective use of alteplase for the clearance of occluded central venous devices.  J Clin Oncol. 2002;  20 1918-1922
  • 68 Haire W D, Deitcher S R, Mullane K M et al.. Recombinant urokinase for restoration of patency in occluded central venous access devices. A double-blind, placebo-controlled trial.  Thromb Haemost. 2004;  92 575-582
  • 69 Moll S, Kenyon P, Bertoli L et al.. Phase II trial of alfimeprase, a novel-acting fibrin degradation agent, for occluded venous devices.  J Clin Oncol. 2006;  24 3056-3060
  • 70 Linenberger M L. Catheter-related thrombosis: risks, diagnosis and management.  J Natl Compr Canc Netw. 2006;  4 889-901
  • 71 Savage K J, Wells P S, Schulz V et al.. Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity.  Thromb Haemost. 1999;  82 1008-1010
  • 72 Frank D A, Meuse J, Hirsch D, Ibrahim J G, van den Abbeele A D. The treatment and outcome of cancer patients with thromboses on central venous catheters.  J Thromb Thrombolysis. 2000;  10 271-275
  • 73 Sabeti S, Schillinger M, Miekusch W, Haumer M, Ahmadi R, Minar E. Treatment of subclavian-axillary thrombosis: long-term outcome of anticoagulation versus thrombosis.  Thromb Res. 2002;  108 279-285
  • 74 Spence L D, Gironta M G, Malde H M et al.. Acute upper extremity deep vein thrombosis: safety and effectiveness of superior venal cava filters.  Radiology. 1999;  210 53-58
  • 75 Ascher E, Hingorani A, Mazzariol F et al.. Clinical experience with superior vena caval Greenfield filters.  J Endovasc Surg. 1999;  6 365-369
  • 76 Wagman L D, Baird M F, Bennett C L et al.. Venous thromboembolic disease. Clinical practice guidelines in oncology.  J Natl Compr Canc Netw. 2006;  4 838-869

César O FreytesM.D. 

Mail Code 7880, 7703 Floyd Curl Drive

San Antonio, TX 78229-3900

Email: freytes@uthscsa.edu

    >