Annals of Oncology Advance Access published online on June 12, 2009
Annals of Oncology, doi:10.1093/annonc/mdp052
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2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the working group
1 Department of Oncology and Internal Medicine, Desgenettes Hospital, Lyons
2 SOR, National Cancer Institute, Boulogne-Billancourt
3 Department of Internal Medicine, La Cavale-Blanche Hospital, Brest
4 Department of Anesthesiology, Curie Institute, Paris
5 Department of Anesthesiology, Gustave Roussy Institute, Villejuif
6 Department of Anesthesiology, Saint Louis Hospital, Paris
7 Hemostasis Laboratory, Tenon Hospital, Paris
8 Department of Pneumology, Georges Pompidou Hospital, Paris
9 Department of Vascular Pathology, Saint-Etienne Hospital, Saint-Étienne
10 Hemostasis Laboratory, Saint-Louis Hospital, Paris
11 Department of Vascular Pathology, Bois Guillaume Hospital, Rouen
12 Department of Vascular Pathology, Georges Pompidou Hospital, Paris
13 Department of Vascular Pathology, Saint-Louis Hospital, Paris, France
* Correspondence to: Dr P. Debourdeau, Hôpital Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France. Tel: +33-4-72-36-61-94; Fax: +33-4-72-36-25-26; E-mail: pdebourdeau{at}yahoo.fr
Background: In view of the lack of recommendations on central venous catheter (CVC)-associated thrombosis in cancer patients, we established guidelines according to the well-standardized Standards, Options and Recommendations methodology.
Material and methods: A literature review (1990–2007) on CVC-associated thrombosis was carried out. The guidelines were developed on the basis of the corresponding levels of evidence derived from analysis of the 36 of 175 publications selected. They were then peer reviewed by 65 independent experts.
Results: For the prevention of CVC-associated thrombosis, the distal tip of the CVC should be placed at the junction between the superior cava vein and right atrium; anticoagulants are not recommended. Treatment of CVC-associated thrombosis should be based on the prolonged use of low-molecular weight heparins. Maintenance of the catheter is justified if it is mandatory, functional, in the right position, and not infected, with a favorable clinical evolution under close monitoring; anticoagulant treatment should then be continued as long as the catheter is present.
Conclusions: Several rigorous studies do not support the use of anticoagulants for the prevention of CVC-associated thrombosis. Treatment of CVC-associated thrombosis relies on the same principles as those applied in the treatment of established thrombosis in cancer patients.
cancer, catheter, clinical practice guidelines, heparin, thrombosis, vitamin K antagonists
Received for publication August 11, 2008. Revision received October 30, 2008. Accepted for publication February 9, 2009.