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Annals of Oncology Advance Access published online on June 30, 2009
Annals of Oncology, doi:10.1093/annonc/mdp235
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Early and short-term acenocumarine or dalteparin for the prevention of central vein catheter-related thrombosis in cancer patients: a randomized controlled study based on serial venographies

M. De Cicco1,*, M. Matovic1, L. Balestreri2, A. Steffan3, R. Pacenzia1, M. Malafronte1, D. Fantin1, C. A. Bertuzzi1, F. Fabiani1, S. Morassut2, E. Bidoli4 and A. Veronesi5

1 Department of Anaesthesiology and Intensive Care, National Cancer Institute, Aviano (PN), Italy
2 Department of Radiology, National Cancer Institute, Aviano (PN), Italy
3 Department of Laboratory Diagnostics, National Cancer Institute, Aviano (PN), Italy
4 Biostatistics and Epidemiology Unit
5 Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy

* Correspondence to: Dr M. De Cicco, Department of Anaesthesiology and Intensive Care, National Cancer Institute, Via Franco Gallini, 2, 33170 Aviano (PN), Italy. Tel: +39-0434659437; Fax: +39-0434659858; E-mail: mdecicco{at}cro.it

Background: We evaluated efficacy and safety of early and short-term prophylaxis with acenocumarine or dalteparin in the prevention of non-occlusive or occlusive central vein catheter-related thrombosis (CVCrT).

Patients and methods: Consecutive cancer patients scheduled for chemotherapy randomly received: acenocumarine 1 mg/day for 3 days before and 8 days after central vein catheter (CVC) insertion; dalteparin 5000 IU 2 h before and daily for 8 days after CVC insertion; no anticoagulant treatment (NT). All patients underwent venography on days 8 and 30, some of them on days 90, 150 and 210 after CVC.

Results: A total of 450 patients were randomized, 348 underwent at least two venography. Both acenocumarine and dalteparin reduced venography-detected CVCrT rate [21.9% acenocumarine versus 52.6% NT, odds ratio (OR) 0.3, P < 0.01; 40% dalteparin versus 52.6% NT, OR 0.6, P = 0.05]. Acenocumarine was more effective than dalteparin (OR 0.4, P = 0.01). The rate of occlusive CVCrT was not different in the three groups (0.9% acenocumarine, 3.3% dalteparin, 1.8% NT; P = 0.40). Most CVCrTs (95.6%) were observed on day 8 after CVC insertion and were non-occlusive.

Conclusions: In this study of early and short-term prophylaxis, acenocumarine was more effective than dalteparin on non-occlusive and asymptomatic CVCrT events. The first days following CVC insertion represent the highest risk for CVCrT.

cancer patients, central vein catheter-related thrombosis, thromboprophylaxis

Received for publication February 6, 2009. Accepted for publication March 16, 2009.


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