Annals of Oncology Advance Access originally published online on December 8, 2006
Annals of Oncology 2007 18(3):551-555; doi:10.1093/annonc/mdl431
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© 2006 European Society for Medical Oncology
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Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis
1 Department of Medicine, Oncology Unit, Azienda Ospedaliera ‘Ospedale Civile’ di Vimercate, Milan
2 Oncology Units of Ospedale di Casalpusterlengo, Lodi
3 Università degli Studi di Pavia e IRCCS San Matteo, Pavia
4 Ospedale Sant'Anna, Como
5 Ospedale Fatebenefratelli, Milan
6 Ospedale di Sondrio, Sondrio
7 Ospedale Valduce, Como
8 Ospedale San Gerardo, Monza
9 Ospedale Sacco, Milan
10 Azienda Ospedaliera Melegnano PO Gorgonzola, Gorgonzola, Mi
11 Ospedale Fatebenefratelli, Erba, Como, Italy
* Correspondence to: Dr D. Fagnani, Department of Medicine, Oncology Unit, Azienda Ospedaliera "Ospedale Civile" di Vimercate, Vimercate Hospital, Via C. Battisti 23, 20059 Vimercate (Milan), Italy. Tel: +39-03-96654725; Fax: 39-03-96654749; E-mail danielefagnani{at}libero.it
Background: Recent guidelines do not recommend antithrombotic prophylaxis (AP) to prevent catheter-related thrombosis in cancer patients with a central line.
Patients and methods: This study assessed the management of central lines in cancer patients, current attitude towards AP, catheter-related and systemic venous thromboses, and survival.
Results: Of 1410 patients enrolled, 1390 were seen at least once in the 6-month median follow-up. Continuous AP, mainly low-dose warfarin, was given to 451 (32.4%); they were older, with a more frequent history of venous thromboembolism (VTE), and more advanced cancer. There was no difference in catheter-related thrombosis in patients given AP or not (2.8% and 2.2%, odds ratio 1.29, 95% confidence interval 0.64–2.6). The median time to first catheter-related complication was 120 days. Systemic VTE including deep and superficial thromboses and pulmonary embolism, were less frequent with AP (4% versus 8.2%, P = 0.005). Mortality was also lower (25% versus 44%, P = 0.0001). Multiple logistic regression analysis found only advanced cancer and no AP significantly associated with mortality. No major bleeding was recorded with AP.
Conclusions: Current AP schedules do not appear to prevent catheter-related thrombosis. Systemic VTE and mortality, however, appeared lower after prophylaxis.
Key words: cancer, catheter-related thrombosis, central venous catheters, deep vein thrombosis, low-dose warfarin, pulmonary embolism
Received for publication July 6, 2006. Revision received September 19, 2006. Accepted for publication October 16, 2006.
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