Catheter-Related Thrombosis: Risks, Diagnosis, and Management

Author:
Michael L. LinenbergerFrom the Division of Hematology and Department of Medicine, University of Washington, and Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington.

Search for other papers by Michael L. Linenberger in
Current site
Google Scholar
PubMedClose
 MD
Volume/Issue:
Volume 4: Issue 9
Online Publication Date:
Oct 2006
DOI:
https://doi.org/10.6004/jnccn.2006.0074
Full access

Symptomatic thromboembolic complications of central venous catheters (CVCs) occur in 5% or less of general oncology patients. Asymptomatic CVC-related thrombi are more common, but their clinical significance is unclear. Thrombotic risk may be increased by primary thrombophilic disorders, especially the factor V G1691A (Leiden) mutation, thrombogenic catheter material, larger catheter diameter and greater number of lumens, catheter tip malposition, left-sided placement, percutaneous or multiple insertion attempts, a previous CVC or preexisting venous obstruction, prothrombotic therapeutic agents, catheter-associated infections, and fibrinous catheter lumen occlusion. Three recent randomized, prospective, placebo-controlled trials observed no benefit of routine low-dose warfarin or low-molecular-weight heparin in preventing catheter-associated thrombosis. Nevertheless, thromboprophylaxis may be appropriate and safe for selected high-risk patients. Duplex ultrasound can accurately detect CVC-related thrombi involving the jugular, axillary, distal subclavian, and arm veins. Contrast venographic imaging is required for indeterminate duplex findings and to evaluate the deep central veins and pulmonary arteries. Therapeutic anticoagulation, with or without catheter removal, is indicated for patients with acute deep vein thrombosis (DVT) or pulmonary embolism who have no contraindications. Catheter removal alone, with close follow-up, may be sufficient when bleeding risk precludes safe anticoagulation. Approaches to managing catheter-associated thrombosis, including the use of thrombolytic agents, are guided by limited published experience and extrapolation from practices used for lower-extremity DVT. Prospective, randomized, controlled trials are needed to identify the safest and most effective anticoagulant agents, treatment durations, and alternative venous access strategies for cancer patients who develop catheter-associated thrombosis.

Correspondence: Michael L. Linenberger, MD, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance (G6-800), 825 Eastlake Avenue E, P.O. Box 19023, Seattle, WA 98109-1023. E-mail: linen@u.washington.edu
  • Collapse
  • Expand
  • 1.

    Heit JA, Silverstein MD, Mohr DN et al.. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000;160:809–815.

    • Search Google Scholar
    • Export Citation
  • 2.

    Joffe HV, Kucher N, Tapson VF et al.. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation 2004;110:1605–1611.

    • Search Google Scholar
    • Export Citation
  • 3.

    Prandoni P, Polistena P, Bernardi E et al.. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 1997;157:57–62.

    • Search Google Scholar
    • Export Citation
  • 4.

    Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Old and new risk factors for upper extremity deep venous thrombosis. J Thromb Haemost 2005;3:2471–2478.

    • Search Google Scholar
    • Export Citation
  • 5.

    Giess CS, Thaler H, Bach AM, Hann LE. Clinical experience with upper extremity venous sonography in a high-risk cancer population. J Ultrasound Med 2002;21:1365–1370.

    • Search Google Scholar
    • Export Citation
  • 6.

    Allen AW, Megargell JL, Brown DB et al.. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:1309–1314.

    • Search Google Scholar
    • Export Citation
  • 7.

    Abdullah BJ, Mohammad N, Sangkar JV et al.. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol 2005;78:596–600.

    • Search Google Scholar
    • Export Citation
  • 8.

    Grove JR, Pevec WC. Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:837–840.

  • 9.

    Walshe LJ, Malak SF, Eagan J, Sepkowitz KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 2002;20:3276–3281.

    • Search Google Scholar
    • Export Citation
  • 10.

    Schwarz RE, Groeger JS, Coit DG. Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis. Cancer 1997;79:1635–1640.

    • Search Google Scholar
    • Export Citation
  • 11.

    Kuriakose P, Colon-Otero G, Paz-Fumagalli R. Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol 2002;13:179–184.

    • Search Google Scholar
    • Export Citation
  • 12.

    Labourey JL, Lacroix P, Genet D et al.. Thrombotic complications of implanted central venous access devices: prospective evaluation. Bull Cancer 2004;91:431–436.

    • Search Google Scholar
    • Export Citation
  • 13.

    Luciani A, Clement O, Halimi P et al.. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001;220:655–660.

    • Search Google Scholar
    • Export Citation
  • 14.

    Tesselaar MET, Ouwerkerk J, Nooy MA et al.. Risk factors for catheter-related thrombosis in cancer patients. Eur J Cancer 2004;40:2253–2259.

  • 15.

    Puel V, Caudry M, Le Metayer P et al.. Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports. Cancer 1993;72:2248–2252.

    • Search Google Scholar
    • Export Citation
  • 16.

    Biffi R, De Braud F, Orsi F et al.. A randomized, prospective trial of central venous ports connected to standard open-ended or Groshong catheters in adult oncology patients. Cancer 2001;92:1204–1212.

    • Search Google Scholar
    • Export Citation
  • 17.

    Haire WD, Lieberman RP, Lund GB et al.. Thrombotic complications of silicone rubber catheters during autologous marrow and peripheral stem cell transplantation: prospective comparison of Hickman and Groshong catheters. Bone Marrow Transplant 1991;7:57–59.

    • Search Google Scholar
    • Export Citation
  • 18.

    Haire WD, Lieberman RP, Edney J et al.. Hickman catheter-induced thoracic vein thrombosis. Frequency and long-term sequelae in patients receiving high-dose chemotherapy and marrow transplantation. Cancer 1990;66:900–908.

    • Search Google Scholar
    • Export Citation
  • 19.

    Conlan MG, Haire WD, Lieberman RP et al.. Catheter-related thrombosis in patients with refractory lymphoma undergoing autologous stem cell transplantation. Bone Marrow Transplant 1991;7:235–240.

    • Search Google Scholar
    • Export Citation
  • 20.

    Eastridge BJ, Lefor AT. Complications of indwelling venous access devices in cancer patients. J Clin Oncol 1995;13:233–238.

  • 21.

    Nightingale CE, Norman A, Cunningham D et al.. 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.

    • Search Google Scholar
    • Export Citation
  • 22.

    Trerotola SO, Kuhn-Fulton J, Johnson MS et al.. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 2000;217:89–93.

    • Search Google Scholar
    • Export Citation
  • 23.

    Molinari AC, Castagnola E, Mazzola C et al.. Thromboembolic complications related to indwelling central venous catheters in children with oncological/haematological diseases: a retrospective study of 362 catheters. Support Care Cancer 2001;9:539–544.

    • Search Google Scholar
    • Export Citation
  • 24.

    Fratino G, Molinari AC, Parodi S et al.. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 2005; 16:648–654.

    • Search Google Scholar
    • Export Citation
  • 25.

    Horne MK III, May DJ, Alexander HR et al.. Venographic surveillance of tunneled venous access devices in adult oncology patients. Ann Surg Oncol 1995;2:174–178.

    • Search Google Scholar
    • Export Citation
  • 26.

    Barzaghi A, Dell'Oto M, Rovelli A et al.. Central venous catheter clots: incidence, clinical significance and catheter care in patients with hematologic malignanices. Pediatr Hematol Oncol 1995;12:243–250.

    • Search Google Scholar
    • Export Citation
  • 27.

    McLean TW, Fisher CJ, Snively BM, Chauvenet AR. Central venous lines in children with lesser risk acute lymphoblastic leukemia: optimal type and timing of placement. J Clin Oncol 2005;23:3024–3029.

    • Search Google Scholar
    • Export Citation
  • 28.

    Khorana AA, Francis CW, Culakova E et al.. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 2006;24:484–490.

  • 29.

    Monreal M, Raventos A, Lerma R et al.. Pulmonary embolism in patients with upper extremity DVT associated to venous central lines—a prospective study. Thromb Haemost 1994;72:548–550.

    • Search Google Scholar
    • Export Citation
  • 30.

    Schwarz RE, Coit DG, Groeger JS. Transcutaneously tunneled central venous lines in cancer patients: an analysis of device-related morbidity factors based on prospective data collection. Ann Surg Oncol 2000;7:441–449.

    • Search Google Scholar
    • Export Citation
  • 31.

    Male C, Chait P, Andrew M et al.. Central venous line-related thrombosis in children: association with central venous line location and insertion technique. Blood 2003;101:4273–4278.

    • Search Google Scholar
    • Export Citation
  • 32.

    De Cicco M, Matovic M, Balestreri L et al.. Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res 1997;86:101–113.

    • Search Google Scholar
    • Export Citation
  • 33.

    Lee AY, Levine MN, Butler G et al.. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol 2006;24:1404–1408.

    • Search Google Scholar
    • Export Citation
  • 34.

    Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med 2002;30:454–460.

    • Search Google Scholar
    • Export Citation
  • 35.

    Blom JW, Doggen CJM, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005;293:715–722.

  • 36.

    Chew HK, Wun T, Harvey D et al.. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006;166:458–464.

    • Search Google Scholar
    • Export Citation
  • 37.

    Haire WD, Lynch TG, Lieberman RP, Edney JA. Duplex scans before subclavian vein catheterization predict unsuccessful catheter placement. Arch Surg 1992;127:229–230.

    • Search Google Scholar
    • Export Citation
  • 38.

    Gupta H, Araki Y, Davidoff AM et al.. Evaluation of pediatric oncology patients with previous multiple central catheters for vascular access: is Doppler ultrasound needed? Pediatr Blood Cancer 2006;Apr 26:Epub ahead of print.

    • Search Google Scholar
    • Export Citation
  • 39.

    Kraybill WG, Allen BT. Preoperative duplex venous imaging in the assessment of patients with venous access. J Surg Oncol 1993;52:244–248.

    • Search Google Scholar
    • Export Citation
  • 40.

    van Rooden CJ, Rosendaal FR, Meinders AE et al.. The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis. Haematologica 2004;89:201–206.

    • Search Google Scholar
    • Export Citation
  • 41.

    Cortelezzi A, Moia M, Falanga A et al.. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol 2005;129:811–817.

    • Search Google Scholar
    • Export Citation
  • 42.

    Lordick F, Hentrich M, Decker T et al.. Ultrasound screening for internal jugular vein thrombosis aids the detection of central venous catheter-related infections in patients with haemato-oncological diseases: a prospective observational study. Br J Haematol 2003;120:1073–1078.

    • Search Google Scholar
    • Export Citation
  • 43.

    van Rooden CJ, Schippers EF, Barge RMY et al.. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study. J Clin Oncol 2005;23:2655–2660.

    • Search Google Scholar
    • Export Citation
  • 44.

    Miceli M, Atoui R, Walker R et al.. Diagnosis of deep septic thrombophlebitis in cancer patients by fluorine-18 fluorodeoxyglucose positron emission tomography scanning: a preliminary report. J Clin Oncol 2004;22:1949–1956.

    • Search Google Scholar
    • Export Citation
  • 45.

    Nowak-Gottl U, Dubbers A, Kececioglu D et al.. Factor V Leiden, protein C, and lipoprotein (a) in catheter-related thrombosis in childhood: a prospective study. J Pediatr 1997;131:608–612.

    • Search Google Scholar
    • Export Citation
  • 46.

    Knofler R, Siegert E, Lauterbach I et al.. Clinical importance of prothrombotic risk factors in pediatric patients with malignancy— impact of central venous lines. Eur J Pediatr 1999;158(suppl 3):S147–S150.

    • Search Google Scholar
    • Export Citation
  • 47.

    Wermes C, von Depka Prondzinski M, Lichtinghagen R et al.. Clinical relevance of genetic risk factors for thrombosis in paediatric oncology patients with central venous catheters. Eur J Pediatr 1999;158(suppl 3):S143–S146.

    • Search Google Scholar
    • Export Citation
  • 48.

    Nowak-Gottl U, Wermes C, Junker R et al.. Prospective evaluation of the thrombotic risk in children with acute lymphoblastic leukemia carrying the MTHFR TT 677 genotype, the prothrombin G20210A variant, and further prothrombotic risk factors. Blood 1999;93:1595–1599.

    • Search Google Scholar
    • Export Citation
  • 49.

    Mauz-Korholz C, Junker R, Gobel U, Nowak-Gottl U. Prothrombotic risk factors in children with acute lymphoblastic leukemia treated with delayed E. coli asparaginase (COALL-92 and 97 protocols). Thromb Haemost 2000;83:840–843.

    • Search Google Scholar
    • Export Citation
  • 50.

    Ruud E, Holmstrom H, Natvig S, Wesenberg F. Prevalence of thrombophilia and central venous catheter-associated neck vein thrombosis in 41 children with cancer—a prospective study. Med Pediatr Oncol 2002;38:405–410.

    • Search Google Scholar
    • Export Citation
  • 51.

    Mitchell LG, Andrew M, Hanna K et al.. A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer 2003;97:508–516.

    • Search Google Scholar
    • Export Citation
  • 52.

    Sifontes MT, Nuss R, Hunger SP et al.. The factor V Leiden mutation in children with cancer and thrombosis. Br J Haematol 1997;96:484–489.

  • 53.

    Riordan M, Weiden PL. Factor V Leiden mutation does not account for central venous catheter-related thrombosis. Am J Hematol 1998;58:150–152.

    • Search Google Scholar
    • Export Citation
  • 54.

    Ratcliffe M, Broadfoot C, Davidson M et al.. 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;21:353–357.

    • Search Google Scholar
    • Export Citation
  • 55.

    Ozguroglu M, Arun B, Erzin Y et al.. Serum cardiolipin antibodies in cancer patients with thromboembolic events. Clin Appl Thromb Hemost 1999;5:181–184.

    • Search Google Scholar
    • Export Citation
  • 56.

    Fijnheer R, Paijmans B, Verdonck LF et al.. Factor V Leiden in central venous catheter-associated thrombosis. Br J Haematol 2002;118:267–270.

  • 57.

    Abdelkefi A, Ben Romdhane N, Kriaa A et al.. Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients. Bone Marrow Transplant 2005;36:885–889.

    • Search Google Scholar
    • Export Citation
  • 58.

    Jansen FH, van der Straaten HM, Roest M et al.. Elevated levels of D-dimer and fragment 1+2 upon central venous catheter insertion and factor V Leiden predict subclavian vein thrombosis. Haematologica 2005;90:499–504.

    • Search Google Scholar
    • Export Citation
  • 59.

    Mandala M, Curigliano G, Bucciarelli P et al.. Factor V Leiden and G20210A prothrombin mutation and the risk of subclavian vein thrombosis in patients with breast cancer and a central venous catheter. Ann Oncol 2004;15:590–593.

    • Search Google Scholar
    • Export Citation
  • 60.

    Cortelezzia A, Fracchiolla NS, Maisonneuve P et al.. Central venous catheter-related complications in patients with hematological malignancies: a retrospective analysis of risk factors and prophylactic measures. Leuk Lymphoma 2003;44:1495–1501.

    • Search Google Scholar
    • Export Citation
  • 61.

    Wun T, Law L, Harvey D et al.. Increased incidence of symptomatic venous thrombosis in patients with cervical carcinoma treated with concurrent chemotherapy, radiation, and erythropoietin. Cancer 2003;98:1514–1520.

    • Search Google Scholar
    • Export Citation
  • 62.

    Eastman ME, Khorsand M, Maki DG et al.. Central venous device-related infection and thrombosis in patients treated with moderate dose continuous-infusion interleukin-2. Cancer 2001; 91:806–814.

    • Search Google Scholar
    • Export Citation
  • 63.

    Stephens LC, Haire WD, Schmit-Pokorny K et al.. Granulocyte macrophage colony stimulating factor: high incidence of apheresis catheter thrombosis during peripheral stem cell collection. Bone Marrow Transplant 1993;11:51–54.

    • Search Google Scholar
    • Export Citation
  • 64.

    Rajkumar SV. Thalidomide therapy and deep venous thrombosis in multiple myeloma. Mayo Clin Proc 2005;80:1549–1551.

  • 65.

    Opatrny L, Warner MN. Risk of thrombosis in patients with malignancy and heparin-induced thrombocytopenia. Am J Hematol 2004;76:240–244.

    • Search Google Scholar
    • Export Citation
  • 66.

    Hong AP, Cook DJ, Sigouin CS, Warkentin TE. Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia. Blood 2003;101:3049–3051.

    • Search Google Scholar
    • Export Citation
  • 67.

    Kuter DJ. Thrombotic complications of central venous catheters in cancer patients. Oncologist 2004;9:207–216.

  • 68.

    Tolar B, Gould JR. The prognostic significance of the ball-valve effect in Groshong catheters. Support Care Cancer 1996;4:34–38.

  • 69.

    Stephens LC, Haire WD, Kotulak GD. Are clinical signs accurate indicators of the cause of central venous catheter occlusion? JPEN J Parenter Enteral Nutr 1995;19:75–79.

    • Search Google Scholar
    • Export Citation
  • 70.

    Baarslag HJ, Koopman MM, Reekers JA, van Beek EJ. Diagnosis and management of deep vein thrombosis of the upper extremity: a review. Eur Radiol 2004;14:1263–1274.

    • Search Google Scholar
    • Export Citation
  • 71.

    Mustafa BO, Rathbun SW, Whitsett TL, Raskob GE. Sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis: a systematic review. Arch Intern Med 2002;162:401–404.

    • Search Google Scholar
    • Export Citation
  • 72.

    Baarslag HJ, van Beek EJ, Koopman MM, Reekers JA. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med 2002;136:865–872.

    • Search Google Scholar
    • Export Citation
  • 73.

    Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003;21:3665–3675.

    • Search Google Scholar
    • Export Citation
  • 74.

    van Rooden CJ, Tesselaar ME, Osanto S et al.. Deep vein thrombosis associated with central venous catheters—a review. J Thromb Haemost 2005;3:2409–2419.

    • Search Google Scholar
    • Export Citation
  • 75.

    Baarslag HJ, van Beek EJ, Reekers JA. Magnetic resonance venography in consecutive patients with suspected deep vein thrombosis of the upper extremity: initial experience. Acta Radiol 2004;45:38–43.

    • Search Google Scholar
    • Export Citation
  • 76.

    Minassian VA, Sood AK, Lowe P et al.. Long-term central venous access in gynecologic cancer patients. J Am Coll Surg 2000;191:403–409.

  • 77.

    Lagro SW, Verdonck LF, Borel Rinkes IH, Dekker AW. No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients. Bone Marrow Transplant 2000;26:1103–1106.

    • Search Google Scholar
    • Export Citation
  • 78.

    Magagnoli M, Masci G, Castagna L et al.. 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.

    • Search Google Scholar
    • Export Citation
  • 79.

    Bozzetti F, Scarpa D, Terno G et al.. Subclavian venous thrombosis due to indwelling catheters: a prospective study on 52 patients. JPEN J Parenter Enteral Nutr 1983;7:560–562.

    • Search Google Scholar
    • Export Citation
  • 80.

    Boraks P, Seale J, Price J et al.. Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies. Br J Haematol 1998;101:483–486.

    • Search Google Scholar
    • Export Citation
  • 81.

    Bern MM, Lokich JJ, Wallach SR et al.. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med 1990;112:423–428.

    • Search Google Scholar
    • Export Citation
  • 82.

    Monreal M, Alastrue A, Rull M et al.. Upper extremity deep venous thrombosis in cancer patients with venous access devices— prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost 1996;75:251–253.

    • Search Google Scholar
    • Export Citation
  • 83.

    Heaton DC, Han DY, Inder A. Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis. Intern Med J 2002;32:84–88.

  • 84.

    Mismetti P, Mille D, Laporte S et al.. 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.

    • Search Google Scholar
    • Export Citation
  • 85.

    Verso M, Agnelli G, Bertoglio S et al.. 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;23:4057–4062.

    • Search Google Scholar
    • Export Citation
  • 86.

    Couban S, Goodyear M, Burnell M et al.. 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;23:4063–4069.

    • Search Google Scholar
    • Export Citation
  • 87.

    Karthaus M, Kretzschmar A, Kroning H et al.. 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;17:289–296.

    • Search Google Scholar
    • Export Citation
  • 88.

    Geerts WH, Heit JA, Clagett GP et al.. Prevention of venous thromboembolism. Chest 2001;119(suppl 1):132S–175S.

  • 89.

    Carr KM, Rabinowitz I. Physician compliance with warfarin prophylaxis for central venous catheters in patients with solid tumors. J Clin Oncol 2000;18:3665–3667.

    • Search Google Scholar
    • Export Citation
  • 90.

    Massicotte P, Julian JA, Gent M et al.. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children: the PROTEKT trial. Thromb Res 2003;109:101–108.

    • Search Google Scholar
    • Export Citation
  • 91.

    Geerts W, Pineo GF, Heit JA et al.. Prevention of venous thromboembolism. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(suppl 3):338S–400S.

    • Search Google Scholar
    • Export Citation
  • 92.

    Cunningham MS, White B, Hollywood D, O'Donnell J. Primary thromboprophylaxis for cancer patients with central venous catheters—a reappraisal of the evidence. Br J Cancer 2006;94:189–194.

    • Search Google Scholar
    • Export Citation
  • 93.

    Huisman MV. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? Yes for special patient groups. J Thromb Haemost 2006;4:10–13.

    • Search Google Scholar
    • Export Citation
  • 94.

    Agnelli G, Verso M. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? No. J Thromb Haemost 2006;4:14–15.

    • Search Google Scholar
    • Export Citation
  • 95.

    Levine M. Is antithrombotic prophylaxis required in cancer patients with central venous catheters? Still an open question. J Thromb Haemost 2006;4:16–18.

    • Search Google Scholar
    • Export Citation
  • 96.

    Abdelkefi A, Ben Othman T, Kammoun L et al.. 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;92:654–661.

    • Search Google Scholar
    • Export Citation
  • 97.

    Magagnoli M, Masci G, Castagna L et al.. High incidence of INR alteration in gastrointestinal cancer patients treated with mini-dose warfarin and 5-fluorouracil-based regimens. Ann Oncol 2006;17:174–176.

    • Search Google Scholar
    • Export Citation
  • 98.

    Semba CP, Deitcher SR, Li X et al.. Treatment of occluded central venous catheters with alteplase: results in 1,064 patients. J Vasc Interv Radiol 2002;13:1199–1205.

    • Search Google Scholar
    • Export Citation
  • 99.

    Haire WD, Deitcher SR, Mullane KM et al.. Recombinant urokinase for restoration of patency in occluded central venous access devices. A double-blind, placebo-controlled trial. Thromb Haemost 2004;92:575–582.

    • Search Google Scholar
    • Export Citation
  • 100.

    Chesler L, Feusner JH. Use of tissue plasminogen activator (rt-PA) in young children with cancer and dysfunctional central venous catheters. J Pediatr Hematol Oncol 2002;24:653–656.

    • Search Google Scholar
    • Export Citation
  • 101.

    Terrill KR, Lemons RS, Goldsby RE. Safety, dose, and timing of reteplase in treating occluded central venous catheters in children with cancer. J Pediatr Hematol Oncol 2003;25:864–867.

    • Search Google Scholar
    • Export Citation
  • 102.

    Liu CY, Jain V, Shields AF, Heilbrun LK. Efficacy and safety of reteplase for central venous catheter occlusion in patients with cancer. J Vasc Interv Radiol 2004;15:39–44.

    • Search Google Scholar
    • Export Citation
  • 103.

    Buller HR, Agnelli G, Hull RD et al.. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl 3):401S–428S.

    • Search Google Scholar
    • Export Citation
  • 104.

    Schmittling ZC, McLafferty RB, Bohannon WT et al.. Characterization and probability of upper extremity deep venous thrombosis. Ann Vasc Surg 2004;18:552–557.

    • Search Google Scholar
    • Export Citation
  • 105.

    Frank DA, Meuse J, Hirsch D et al.. The treatment and outcome of cancer patients with thromboses on central venous catheters. J Thromb Thrombolysis 2000;10:271–275.

    • Search Google Scholar
    • Export Citation
  • 106.

    Hingorani A, Ascher E, Lorenson E et al.. Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population. J Vasc Surg 1997;26:853–860.

    • Search Google Scholar
    • Export Citation
  • 107.

    Monagle P, Adams M, Mahoney M et al.. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res 2000;47:763–766.

    • Search Google Scholar
    • Export Citation
  • 108.

    Kooij JD, van der Zant FM, van Beek EJ, Reekers JA. Pulmonary embolism in deep venous thrombosis of the upper extremity: more often in catheter-related thrombosis. Neth J Med 1997;50:238–242.

    • Search Google Scholar
    • Export Citation
  • 109.

    Ascher E, Salles-Cunha S, Hingorani A. Morbidity and mortality associated with internal jugular vein thromboses. Vasc Endovascular Surg 2005;39:335–339.

    • Search Google Scholar
    • Export Citation
  • 110.

    Bajzar L, Chan AK, Massicotte MP, Mitchell LG. Thrombosis in children with malignancy. Curr Opin Pediatr 2006;18:1–9.

  • 111.

    Savage KJ, Wells PS, Schulz V et al.. Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost 1999;82:1008–1010.

    • Search Google Scholar
    • Export Citation
  • 112.

    Karabay O, Yetkin U, Onol H. Upper extremity deep vein thrombosis: clinical and treatment characteristics. J Int Med Res 2004;32:429–435.

  • 113.

    Herishanu Y, Misgav M, Kirgner I et al.. Enoxaparin can be used safely in patients with severe thrombocytopenia due to intensive chemotherapy regimens. Leuk Lymphoma 2004;45:1407–1411.

    • Search Google Scholar
    • Export Citation
  • 114.

    Levine MN, Raskob G, Beyth RJ et al.. Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(suppl 3):287S–310S.

    • Search Google Scholar
    • Export Citation
  • 115.

    Ascher E, Hingorani A, Tsemekhin B et al.. Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters. J Vasc Surg 2000;32:881–887.

    • Search Google Scholar
    • Export Citation
  • 116.

    Nadkarni S, Macdonald S, Cleveland TJ, Gaines PA. Placement of a retrievable Gunther Tulip filter in the superior vena cava for upper extremity deep venous thrombosis. Cardiovasc Intervent Radiol 2002;25:524–526.

    • Search Google Scholar
    • Export Citation
  • 117.

    Sabeti S, Schillinger M, Mlekusch W et al.. Treatment of subclavian-axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis. Thromb Res 2002;108:279–285.

    • Search Google Scholar
    • Export Citation
  • 118.

    Volkow P, Cornejo-Juarez P, Arizpe-Bravo AB et al.. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials. Thromb J 2005;3:11.

    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2006 by the National Comprehensive Cancer Network
Page Numbers:
13
Article Category:
Research Article
Received:
17 Jul 2006
Accepted:
28 Jul 2006
Print Publication Date:
01 Oct 2006
Online Publication Date:
Oct 2006
Keywords:
Thrombosis; central venous catheter; deep vein thrombosis; pulmonary embolism; anticoagulation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1064 294 28
PDF Downloads 989 334 36
EPUB Downloads 0 0 0