Catheter-related Deep Vein Thrombosis Research Articles

Factor V Leiden mutation in patients with breast cancer and a central venous catheter: Relationship with deep vein thrombosis

8020 Background: Disorders of coagulation are encountered in up to 90% of cancer patients (pts), although only 15% of them develop a localized acute or chronic deep venous thrombosis (DVT) or a disseminated intravascular coagulation. Aim of the study was to assess the influence of the prothrombotic factor V Leiden and G20210A prothrombin mutation on the prevalence of the 1st event of catheter-related deep vein thrombosis in a cohort of pts with locally advanced or metastatic breast cancer during continuous venous insult (infusion of fluorouracil-based chemotherapy). Methods: Between 1.1999 and 2.2001, we retrospectively analyzed the incidence of first deep vein thrombosis in 300 consecutive pts with locally advanced or metastatic breast cancer treated in a single institution with a combination of chemotherapy administered continuously through a totally implanted access port. We identified 25 women (study group; cases) with catheter-related deep vein thrombosis. For each we selected two pts (50 pts - controls) for identical chemotherapy, similar age, stage of disease and prognostic features. The prothrombotic factor V Leiden and prothrombin mutation G20210A genotype analyses were performed in all patients who signed a specific informed consent. All samples were blinded. Results: All 25 cases and 50 frequency-matched controls were evaluated for Factor V Leiden. Five cases and 2 controls were found with the mutation in the factor V Leiden for a frequency of 20% (95% CI= 9%–39%) and 4% (95% CI=1%-14%) respectively. Thus, the frequency of the mutation was significantly higher in the cases than in controls (p=0.04) and a logistic regression analysis, adjusted by age, yielded an odds ratio of 6.1 (95% CI=1.1–34.3; p=0.04). Only one patient (case) was found with the G20210A mutation in the prothrombin gene. Conclusions: Factor V Leiden carriers with locally advanced or metastatic breast cancer are at high risk of catheter-related deep vein thrombosis during chemotherapy. Clinicians should be aware of this increased risk and antithrombotic phophylaxis should be considered for these patients. No significant financial relationships to disclose.

Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: a prospective study.

To estimate the incidence and to characterize risk factors for central venous catheter (CVC)-related deep vein thrombosis (DVT) in a pediatric intensive care unit. Consecutive children admitted to a pediatric intensive care unit who required a CVC for more than 48 hours were examined by Doppler ultrasonography of the catheterized vein at days 2, 4, 6, or 7 after insertion and weekly thereafter until CVC removal. The incidence of CVC-related DVT was 18.3% (17 of 93) (95% confidence interval = 10.2% to 25.8%). Thromboses were diagnosed within the first 4 days of catheter placement for 15 of 17 CVC-related thromboses. Multivariate analysis showed that risk factors most predictive of CVC-related DVT were presence of a cancer (odds ratio = 17.23, 95% confidence interval = 1.5 to 194) and young age (odds ratio for age = 0.72, 95% confidence interval = 0.54 to 0.96). The frequency of CVC-related DVT is substantial in pediatric intensive care units. Risk is highest during the 4 days after insertion and decreases thereafter. The clinical impact, optimal prevention, and therapy of these thromboses remain to be determined.

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

Central venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism. We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested. On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% CI: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 +/- 145 vs 207 +/- 81 x 10(9)/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.