Systemic Anticoagulant Prophylaxis for Central Catheter–Associated Venous Thrombosis in Cancer Patients

Abstract

Spanish

French

Objective:

To review the literature regarding the incidence of thrombosis in cancer patients with central venous catheters (CVCs) and weigh the evidence supporting thromboprophylaxis in this patient population.

Data Sources:

Clinical literature was identified by searching MEDLINE (1966–February 2007) using the key search terms malignancy, cancer, catheters, prophylaxis, thrombosis, and central venous catheters.

Study Selection and Data Extraction:

An evaluation of retrospective and prospective clinical trials that studied the use of systemic anticoagulants (eg, warfarin, heparin, and low-molecular-weight heparin [LMWH]) to prevent thrombosis with CVCs was performed. Different patient populations, including those manifesting with solid tumor or hematologic malignancy and those undergoing hematopoietic stem cell transplant, were evaluated for this review.

Data Synthesis:

Thrombosis associated with CVCs is a common complication in cancer patients. Most CVC thrombosis will occur within 30 days after placement, with a majority within 8 days. The incidence may depend on the type of CVC and location of the catheter tip. Despite recommendations against the use of systemic anticoagulation for prophylaxis against CVC thrombosis, a potential role continues to be explored in selected settings. Several variables are noted between published clinical trials, making any comparisons difficult to determine whether any benefit exists. Generally, the use of mini-dose warfarin, LMWH, or low-dose unfractionated heparin did not consistently reach significance in reporting a reduction in CVC thrombosis.

Conclusions:

Available data do not support the routine use of anticoagulants for thromboprophylaxis to prevent CVC-related thrombosis. However, several inconsistencies can be found in the studies done to date. More studies are needed to identify subsets of cancer patients who are at higher risk of developing CVC thrombosis and may benefit from prophylactic systemic anticoagulation.

Keywords

anticoagulation cancer catheters thrombosis

Get full access to this article

View all access options for this article.

References

Kuter

. Thrombotic complications of central venous catheters in cancer patients. The Oncologist 2004;9:207–16.

Tesselaar

MET

Ouwerkerk

Nooy

Rosendaal

Osanto

. Risk factors for catheter-related thrombosis in cancer patients. Eur J Cancer 2004;40:2253–9.

Eastridge

Lefor

. Complications of indwelling venous access devices in cancer patients. J Clin Oncol 1995;13:233–8.

Anderson

Krasnow

Boyer

. Thrombosis: the major Hickman catheter complication in patients with solid tumor. Chest 1989;95:71–5.

Paolietti

Ripani

Antonelli

Nicoletta

. Central venous catheters: observations on the implantation technique and its complications. Minerva Anestesiol 2005;71:555–60.

Geerts

Pineo

Heit

. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126(suppl):338S–400S.

De Cico

Matovic

Balestreri

. Antithrombin III deficiency as a risk factor for catheter-related central vein thrombosis in cancer patients. Thromb Res 1995;78:127–37.

Cortelezzi

Moia

Falanga

. Incidences of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol 2005;129:811–7.

Magagnoli

Masci

Castagna

. Prophylaxis of central venous catheter–related thrombosis with minidose warfarin in patients treated with high-dose chemotherapy and peripheral-blood stem-cell transplantation: retrospective analysis of 228 cancer patients. Am J Hematol 2006;81:1–4.

10.

Conlan

Haire

Lieberman

Lund

Kessinger

Armitage

. Catheter-related thrombosis in patients with refractory lymphoma undergoing autologous stem cell transplantation. Bone Marrow Transplant 1991;7:235–40.

11.

Bern

Lokich

Wallach

. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med 1990;112:423–8.

12.

Couban

Goodyear

Burnell

: 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;23:1–7.

13.

Ratcliffe

Broadfoot

Davidson

Kelly

Greaves

. Thrombosis, markers of thrombotic risk, indwelling central venous catheters and antithrombotic prophylaxis using low-dose warfarin in subjects with malignant disease. Clin Lab Haematol 1999;21:353–7.

14.

Heaton

Han

Inder

. Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis. Intern Med J 2002;32:84–8.

15.

Boraks

Seale

Price

. Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies. Br J Haematol 1998;101:483–6.

16.

Monreal

Alastrue

Rull

. Upper extremity deep venous thrombosis in cancer patients with venous access devices–prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost 1996;75:251–3.

17.

Karthaus

Kretzschmar

Kroning

. 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;17:289–96.

18.

Verso

Agnelli

Bertoglio

. 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;23:1–6.

19.

Mismetti

Mille

Laporte

. 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.

20.

Lagro

Verdonck

Borel Rinkes

Dekker

. No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients. Bone Marrow Transplant 2000;26:1103–6.

21.

Abdelkefi

Ben Othman

Kammoun

. Prevention of central venous line–related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial. Thromb Haemost 2004;92:654–61.

22.

Nightingale

Norman

Cunningham

Young

Webb

Filshie

. 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.

23.

Abdelkefi

Ben Romdhane

Kriaa

. Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients. Bone Marrow Transplant 2005;36:885–9.

24.

Masci

Magagnoli

Zucali

. Minidose warfarin prophylaxis for catheter-associated thrombosis in cancer patients: can it be safely associated with fluorouracil-based chemotherapy? J Clin Oncol 2003;21:736–9.

25.

Magagnoli

Masci

Castagna

. High incidence of haemostatic interference in cancer patients treated with FOLFOX regimen and concomitant minidose of warfarin. Br J Haematol 2005;129:706–10.

26.

Magagnoli

Masci

Castagna

Morenghi

Santoro

. High incidence of INR alteration in gastrointestinal cancer patients treated with mini-dose warfarin and 5-fluorouracil–based regimens. Ann Oncol 2006;17:174–6.

27.

Fagnani

Franchi

Porta

. Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis. Ann Oncol 2007;18:551–5.

28.

Attal

Huguet

Rubie

. Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low-dose heparin: a prospective, randomized trial. Blood 1992;11:2834–40.

29.

Opatrny

Warner

. Risk of thrombosis in patients with malignancy and heparin-induced thrombocytopenia. Am J Hematol 2004;76:240–4.

30.

Horne

McCloskey

Calis

Wesley

Childs

Kasten-Sportes

. Use of heparin versus lepirudin flushes to prevent withdrawal occlusion of central venous access devices. Pharmacotherapy 2006;26:1262–7.