Abstract
Central venous catheters (CVCs) have improved the management of patients with cancer substantially, by facilitating chemotherapy and supportive therapy. The use of CVCs is associated with complications such as infection and upper-limb deep vein thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to the use of CVCs ranges between 2% and 4%. In the most recent study, the incidence of CVC-related thrombosis, as screened by venography, was approximately 18% in the absence of prophylaxis. In cancer patients with CVC-related UL-DVT, the incidence of clinically overt pulmonary embolism was between 15% and 25%, and the incidence of autopsy-proven pulmonary embolism was up to 50%. Pathogenic factors for CVC-related thrombosis include vessel injury caused by the CVC insertion procedure, venous stasis because of the indwelling CVC, and hypercoagulability associated with cancer. Recent studies have not confirmed a benefit for prophylaxis with antithrombotic agents for CVC-related thrombosis. The recommended treatment for CVC-related thrombosis is based on long-term anticoagulant therapy, with or without catheter removal.
Key Points
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The use of long-term CVCs is associated with major complications, which can occur early (during the insertion procedure) or later (during the catheter dwell). The later complications are infection and upper-limb DVT
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The incidence of symptomatic catheter-related DVT was recently found to be lower than 5%
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Recent studies did not confirm a benefit for prophylaxis of CVC-related thrombosis with antithrombotic agents
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Routine prophylaxis should not be recommended in cancer patients with a CVC
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Recognition of risk factors associated with CVC-related DVT may help to define the subgroup of cancer patients using CVCs who would benefit from prophylaxis
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Agnelli, G., Verso, M. Therapy Insight: venous-catheter-related thrombosis in cancer patients. Nat Rev Clin Oncol 3, 214–222 (2006). https://doi.org/10.1038/ncponc0458
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DOI: https://doi.org/10.1038/ncponc0458
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