Marc L Ellis1,2, Satomi Okano3, Andrew McCann4, Angela McDowall1, Rosita Van Kuilenburg1, Alexandra L McCarthy1,5, Warren Joubert1, John Harper6, Mark Jones3, Peter Mollee1,2. 1. Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia. 3. School of Public Health, University of Queensland, Brisbane, Queensland, Australia. 4. Department of Vascular Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 5. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 6. Department of Interventional Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. AIM: To review the incidence and risk factors for catheter-related thrombosis (CRT) in cancer patients with a CVAD. METHODS: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. RESULTS: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9-170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39-0.84 for age 50-61 years, and HR 0.63; 95% CI 0.45-0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19-2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00-1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57-1.05; P = 0.10). CONCLUSIONS: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.
BACKGROUND: Central venous access devices (CVAD) are commonly employed in the management of cancerpatients. While having several benefits they are associated with significant risks. AIM: To review the incidence and risk factors for catheter-related thrombosis (CRT) in cancerpatients with a CVAD. METHODS: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. RESULTS: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9-170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39-0.84 for age 50-61 years, and HR 0.63; 95% CI 0.45-0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19-2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00-1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57-1.05; P = 0.10). CONCLUSIONS: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.
Authors: Ceder H van den Bosch; Judith Spijkerman; Marc H W A Wijnen; Idske C L Kremer Hovinga; Friederike A G Meyer-Wentrup; Alida F W van der Steeg; Marianne D van de Wetering; Marta Fiocco; Indra E Morsing; Auke Beishuizen Journal: Support Care Cancer Date: 2022-07-01 Impact factor: 3.359