Catheter-related Thrombosis In Patients Research Articles

Incidence and risk factors of PICC-related thrombosis in breast cancer: a meta-analysis.

The incidence and risk factors of peripherally inserted central catheter-related thrombosis in patients with breast cancer have not been fully elucidated. Meta-analysis was performed by searching all studies on the incidence of peripherally inserted central catheter-associated thrombosis and risk factors for its formation in breast cancer patients from the establishment of the database to May 2023, including PubMed, Embase, Web of Science, China Knowledge Network, China Biomedical Literature Service System (SinoMed) and Wanfang databases. Then the incidence of peripherally inserted central catheter-related thrombosis and risk factors for its formation were analyzed in breast cancer patients. A total of 15 articles were included, involving 8635 patients. The total incidence of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%) and 12.9% (95% confidence interval: 7.0-22.5%) after correction. Thirty-two risk factors were included, and eight risk factors could be combined. Among these risk factors, there were statistically significant differences (P<0.05) in body mass index≥25 (odds ratio=6.319, 95% confidence interval: 2.733-14.613; P<0.001), D-dimer >500ng/ml (odds ratio=1.436, 95% confidence interval: 1.113-1.854; P=0.005), increased fibrinogen (odds ratio=4.733, 95% confidence interval: 1.562-14.346; P=0.006), elevated platelet count (odds ratio=4.134, 95% confidence interval: 2.694-6.346; P<0.001) and catheter malposition (odds ratio=8.475, 95% confidence interval: 2.761-26.011; P<0.001). The incidence rate of peripherally inserted central catheter-related thrombosis in breast cancer patients was 7.0% (95% confidence interval: 4.0-13.0%). Body mass index≥25, D-dimer >500ng/ml, elevated fibrinogen, elevated platelet count and catheter malposition were risk factors for peripherally inserted central catheter-related thrombosis in breast cancer patients.

UPPER LIMB LYMPHEDEMA IMPACTS THE RISK OF PERIPHERALLY INSERTED CENTRAL CATHETER-RELATED THROMBOSIS IN PATIENTS WITH BREAST CANCER

There is little information on the risk for catheter-related thrombosis in patients with upper limb lymphedema following breast cancer treatment. We investigated the association between upper limb lymphedema and the risk of peripherally inserted central catheterrelated thrombosis (PICC-RT) occurring in the contralateral limb of patients with breast cancer. A retrospective review analyzed all patients with breast cancer who underwent PICC insertion at a cancer hospital in Hunan Province from 2015 to 2019. Upper limb lymphedema was indexed from hospital information system (HIS) before the occurrence of PICC-RT developed in the contralateral limb. Cox regression analysis was used to evaluate the association of factors with outcome. A total of 1,262 patient records were found and 50 cases of PICC-RT were identified. Forty of these occurred in patients without lymphedema (n=1,236) and 10 in patients with upper limb lymphedema (n=26). After adjustment for various co-variables, Cox regression analysis showed that upper limb lymphedema was significantly associated with increased risk of PICC-RT (hazard ratio=12.128, 95% confidence interval=5.551-26.501; P&lt;0.001). In breast cancer patients, upper limb lymphedema may be an important predictor for PICC-RT in the contralateral limb and information should be provided to patients.

Development and validation of a prediction model of catheter-related thrombosis in patients with cancer undergoing chemotherapy based on ultrasonography results and clinical information

Central venous catheters can be used conveniently to deliver medications and improve comfort in patients with cancer. However, they can cause major complications. The current study aimed to develop and validate an individualized nomogram for early prediction of the risk of catheter-related thrombosis (CRT) in patients with cancer receiving chemotherapy. In total, 647 patients were included in the analysis. They were randomly assigned to the training (n = 431) and validation (n = 216) cohorts. A nomogram for predicting the risk of CRT in the training cohort was developed based on logistic regression analysis results. The accuracy and discriminatory ability of the model were determined using area under the receiver operating characteristic curve (AUROC) values and calibration plots. Multivariate logistic regression analysis showed that body mass index, risk of cancer-related thrombosis, d-dimer level, and blood flow velocity were independent risk factors of CRT. The calibration plot showed an acceptable agreement between the predicted and actual probabilities of CRT. The AUROC values of the nomogram were 0.757 (95% confidence interval: 0.717–0.809) and 0.761 (95% confidence interval: 0.701–0.821) for the training and validation cohorts, respectively. Our model presents a novel, user-friendly tool for predicting the risk of CRT in patients with cancer receiving chemotherapy. Moreover, it can contribute to clinical decision-making.

Central venous catheters-related-thrombosis and risk factors in oncological patients: A retrospective evaluation of recent risk scores.

Insertions of central venous catheters (CVC) has become a common practice in Onco-Hematologic Units to administer systemic treatments. Unfortunately they can cause complications influencing patient's care-pathway significantly. Oncological patients have a higher thrombotic risk than the general population, therefore specific recent risk scores are spreading through the clinical practice, such as Khorana, Protecht, COMPASS-CAT, and Michigan scores. A retrospective cohort of 177 out of a total of 3046 outpatients accessing the Medical Day Hospital of Istituto Nazionale Tumori di Milano from March 2019 to February 2021 aged ⩾ 18 years who developed CVC complications was analyzed extracting clinical data from their medical records. Focusing on the risk factors, especially through recent risk scores to estimate the thrombotic risk we used Wilcoxon-test for continuous variables and the Pearson-Chi-Square test for categorical variables. Anticoagulants resulted a protective factor mostly for partial CVC occlusion (p = 0.0001), preventing CVC occlusions. CVC occlusions were significantly associated with epitelial tumor histotype, (p = 0.0061). Complete CVC occlusions were significantly associated with peripherical inserted central venous catheters (PICC) (p < 0.0001). Catheter-related-thrombosis (CRT) was significantly associated with peripherical-inserted-central-venous-catheter, both when it was diagnosed clinically (p = 0.0121) and radiographically (p = 0.0168).There was a strong association between CRT and a high grade of Khorana Score (p = 0.0195), Protecht Score (p = 0.0412), COMPASS-CAT Score (p = 0.0027). A positive statistical trend was observed between the Michigan Score and CRT in patients carrying PICC (p = 0.053). There are many different and various factors associated with higher or lower risk of CVC thrombotic complications, so it could be useful to test the recent risk scores to estimate thrombotic risk in oncological patients in clinical practice.

A prediction model for central venous catheter-related thrombosis in patients with newly-diagnosed acute myeloid leukemia: A derivation cohort analysis

BackgroundCatheter-related thrombosis (CRT) is a common complication in cancer patients, that may lead to chemotherapy deferral, elevated risk for systemic infections and pulmonary embolism. This study aimed to assess CRT incidence and risk factors in newly-diagnosed acute myeloid leukemia (AML) patients and create predictive models potentially allowing to decrease CRT occurrence in this population. MethodsThis retrospective single-center analysis included all AML patients treated at the Rambam Health Care Campus between 2006 and 2019. Patient clinical and laboratory data were collected to evaluate thrombosis occurrence and time from AML diagnosis to CRT development. Multivariate classification models were created using logistic regression (LR) and competing risk analyzes. ResultsThe final analysis included 632 newly-diagnosed AML patients (mean age 54 ± 15 years). CRT incidence was 10.1% [confidence interval (CI) 7.7–12.9%], median time from AML diagnosis to CRT was 12.5 days [interquartile range 6–30]. In an LR multivariate model, prior history of venous thromboembolism [adjusted odds ratio (AOR) 12.046, p < 0.0001], acute promyelocytic leukemia (APL) (AOR 2.824, p = 0.015), a high body mass index and initial platelet counts <100 × 10E9/L (AOR 1.059 and 0.546; p = 0.011 and 0.040, respectively) were significantly associated with high CRT risk. Analysis of 587 non-APL patients demonstrated comparable results, with CRT incidence of 9.3% (CI 7.0%-12.1%) and emergence of chronic obstructive pulmonary disease (COPD) as a novel significant co-factor (AOR 34.491, p = 0.004). In both models, the area under curve (AUC) was ≥70%. ConclusionsSignificant CRT risk factors defined using the created model could be used for identification of high-risk newly-diagnosed AML patients requiring CRT prophylaxis.

Catheter-related thrombosis after cardiac surgery in patients with both central venous and pulmonary artery catheters inserted into the right internal jugular vein: a single-center, prospective, observational study.

Central venous catheters (CVCs) and pulmonary artery catheters (PACs) are widely used in intensive care and perioperative management. The detection and prevention of catheter-related thrombosis (CRT) are important because CRT is a complication of catheter use and can cause pulmonary embolism and bloodstream infection. Currently, there is no evidence for CRT in patients using both CVC and PAC. We conducted a single-center, prospective, observational study to identify the incidence, timing, and risk factors for CRT in patients undergoing cardiovascular surgery and using a combination of CVC and PAC through the right internal jugular vein (RIJV). Out of 50 patients, CRT was observed using ultrasonography in 39 patients (78%), and the median time of CRT formation was 1day (interquartile range: 1-1.5) after catheter insertion. The mean duration of PAC placement was 3days (interquartile range: 2-5), and the maximum diameter of CRT was 12mm (interquartile range: 10-15). In short-axis images, CRT occupied more than half of the cross-sectional area of the RIJV in five patients (10%), and CRT completely occluded the RIJV in one patient (2%). Platelet count, duration of PAC placement, and intraoperative bleeding amount were found to be high-risk indicators of CRT. In conclusion, patients who underwent cardiovascular surgery and using both CVC and PAC had a high incidence of CRT. Avoiding unnecessary PAC placement and early removal of catheters in patients at high risk of developing CRT may prevent the development of CRT.

Risk Factors for Catheter-Related Thrombosis in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation.

Background and Objectives: Cancer associated thrombosis (CAT) is a common complication of neoplasms. Multiple myeloma (MM) carries one of the highest risks of CAT, especially in the early phases of treatment. Autologous stem cell transplantation (ASCT) as the standard of care in transplant-eligible patients with MM carries a risk of catheter-related thrombosis (CRT). The aim of this study was identification of the risk factors of CRT in MM patients undergoing ASCT in 2009–2019. Materials and Methods: We retrospectively analyzed patients with MM undergoing ASCT. Each patient had central venous catheter (CVC) insertion before the procedure. The clinical symptoms of CRT (edema, redness, pain in the CVC insertion area) were confirmed with Doppler ultrasound examination. We examined the impacts of four groups of factors on CRT development: (1) patient-related: age, gender, Body Mass Index (BMI), obesity, Charlson comorbidity index, hematopoietic stem cell transplantation comorbidity index, renal insufficiency, and previous thrombotic history; (2) disease-related: monoclonal protein type, stage of the disease according to Salmon–Durie and International Staging System, number of prior therapy lines, and MM response before ASCT; (3) treatment-related: melphalan dose, transplant-related complications, and duration of post-ASCT neutropenia; (4) CVC-related: location, time from placement to removal. Results: Symptomatic CRT was present in 2.5% (7/276) of patients. Univariate analysis showed an increased risk of CRT in patients with a catheter-related infection (OR 2.4, 95% CI; 1.109–5.19, p = 0.026), previous thrombotic episode (OR 2.49, 95% CI; 1.15–5.39, p = 0.021), previous thrombotic episode on initial myeloma treatment (OR 2.75, 95% CI; 1.15–6.53, p = 0.022), and gastrointestinal complications of ASCT such as vomiting and diarrhea (OR 3.87, 95% CI; 1.57–9.53, p = 0.003). In multivariate analysis, noninfectious complications were associated with higher CRT incidence (OR 2.75, 95% CI; 1.10–6.19, p = 0.031). Conclusions: The incidence of symptomatic CRT in ASCT in MM was relatively low. Previous thrombotic events, especially during the induction of myeloma treatment, increased CRT risk during ASCT. Dehydration following gastrointestinal complications may predispose to higher CRT incidence.

A model to assess the risk of peripherally inserted central venous catheter-related thrombosis in patients with breast cancer: a retrospective cohort study

Limited risk assessment tool to stratify the risk of PICC-related thrombosis (PICC-RVT) in breast cancer patients. This study developed a model to assess the risk of PICC-RVT in breast cancer patients. We conducted a retrospective cohort study of 1284 breast cancer patients receiving PICC insertion from January 1, 2015, to August 31, 2019, at a cancer specialized hospital in Hunan province, China. The entire population was divided into two groups at a ratio of 3:1 which included a derivation sample (n = 978), and a validation sample (n = 284). PICC-RVT was confirmed by ultrasonography in the presence of clinical symptoms and signs. PICC-RVT occurred in 40 (4.09%) of the derivation sample patients. Multivariable analysis identified 9 variables: chronic obstructive pulmonary disease, prior central venous catheter placement, higher level of platelets, higher level of D-dimer, lower level of activated partial thromboplastin time, menopause, no prior breast surgery, upper extremity lymphedema, and endocrine therapy. Points were assigned to each variable according to regression coefficient. The model had an area under the receiver operating characteristics curve (AUC) of 0.850 (95% CI 0.776 to 0.924), The Hosmer-Lemeshow goodness-of-fit was 5.780 (p = 0.328). At a cutoff value of 3.5, the sensitivity and specificity were 75% and 83%, respectively. Several disease-specific factors of breast cancer (e.g., menopause, endocrine therapy, and upper extremity lymphedema) play important roles in the development of PICC-RVT. Patients at higher PICC-RVT risk could be candidates for close post-insertion monitoring and interventions to prevent PICC-RVT.

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Background: Catheter-related thrombosis (CRT) occurs frequently during autologous hematopoietic cell transplantation (AHCT) and its current management is highly variable. There is limited data regarding the incidence, risk factors, management patterns and outcomes of CRT in patients with lymphoma or myeloma undergoing AHCT.Methods: In a retrospective observational study with nested case-control risk factor analysis, we examined 789 patients with lymphoma and myeloma who underwent AHCT at University of Minnesota between 2006-2016. We identified 50 subjects with CRT from central venous catheters (CVCs). Patient and transplant characteristics and outcomes were compared in the case-control analysis with 2:1 matching by patient age and disease. All AHCT recipients underwent insertion of tunneled 14.5fr double lumen large bore tunneled catheters for hematopoietic cell apheresis. All patients underwent routine CT chest prior to AHCT and at days 28 and 100 post-transplant. The primary objective was to describe the CRT incidence, management and complications. Secondary objective was to identify CRT risk factors. Statistical comparison of categorical variables was performed by χ2 and Wilcoxon rank-sum test was used for assessment of continuous variables between cases and controls.Results: The incidence of CRT in patients with lymphoma and myeloma undergoing AHCT over the ten-year period was 6.3% (n=50); with 32% symptomatic. Out of 50 cases, 43 occurred within 100 days of AHCT and 94% cases were associated with tunneled line; predominantly internal jugular (90%). CRT was diagnosed between 21 days prior to 26 days after CVC insertion. Five patients had pulmonary embolism detected incidentally by CT imaging; all were asymptomatic. The median time from tunneled line placement to CRT was 44 days (11-89 days) Of the 50 patients with CRT, 22% had refractory Hodgkin's lymphoma (incidence in HL 11.0%), 62% non-Hodgkin's lymphoma (incidence in NHL 10.1%) and 16% myeloma (incidence in MM 2.1%). The median age at the time of CRT was 56.6 years; 60% were male. Prior radiation to chest/neck (18%), bulky mediastinal mass (12%), splenectomy (6%), bacteremia (18%), hormonal therapy (8%), and prior VTE (16%) were common amongst CRT cases. Half of CRT cases had a Port-a-cath and 46% had more than one CVC inserted peritransplant. Vein occlusion was complete in 46% and occurred with the same frequency on left and right (44% vs 42%). At the time of CRT, median platelet count was 133 (range 31-426 x 109/L). Median time of tunneled line removal was 0 days (ie. on same day as CRT) but ranged from 21 days before CRT to 161 days after CRT.Most (86%) CRTs were treated with low molecular weight heparin (LMWH) and 56% received subsequent warfarin. Only 2% were treated with unfractionated heparin. LMWH at dose 1 mg/kg twice daily was administered if platelet count could be maintained above 50 x 109/L and median time to platelet recovery was 15 days (range 9-36). Patients were anticoagulated for <3 months (38%), 3-6 months (24%), and >6 months (22%). One patient required lytic therapy for CRT. Only two patients (4%) received secondary prophylactic anticoagulation after AHCT. This management was safe and effective and grade 1-2 bleeding events occurred in only two patients (4%) during anticoagulation. Five patients (10%) had CRT recurrence or extension while 12% had subsequent VTE after CRT. No deaths occurred due to CRT or its treatment.In univariate analysis, risk factors for CRT included prior VTE event (20.9% vs 7.0%, p=0.02) and higher WBC peak at mobilization (43.5 vs 40.4 x 109/L, p=0.17) and stem cell engraftment (15.2 vs 11.9 x 109/L, p=0.18). Gender, presence of Port-a-cath, comorbidity index and Karnofsky score did not increase the risk of CRT. Two-year progression-free survival of entire group was 54% (95% CI 50-57%) and was not affected by CRT (p=0.42).Conclusions: The diagnosis of CRT complicates AHCT and appears to be more common in patients with lymphoma than myeloma. Prior VTE is the main risk factor for CRT. Anticoagulation with LMWH or warfarin appeared safe , however many patients had recurrent VTE events. Higher WBC seems to be associated with risk of thrombosis. Further study to define additional risk factors and examine the management strategies is warranted. DisclosuresBachanova:Seattle-Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Zymogen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Oxis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Juno: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Treatment of catheter-related thrombosis in patients with hematologic malignancies: A Venous thromboEmbolism Network U.S. retrospective cohort study

IntroductionOptimal treatment of catheter-related thrombosis (CRT) is uncertain in patients with hematologic malignancy. We aimed to evaluate the treatment strategies, outcomes, and predictors of recurrent venous thromboembolism (VTE) associated with catheter-related thrombosis (CRT) in patients with hematologic malignancy. MethodsWe performed a multicenter retrospective cohort study of eight institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies with documented CRT were identified using ICD-9 and ICD-10 diagnostic codes. Semi-competing risks proportional hazard regression models were created. Results and conclusionsOf the 663 patients in the cohort, 124 (19%) were treated with anticoagulation alone, 388 (58%) were treated with anticoagulation and catheter removal, 119 (18%) treated with catheter removal only, and 32 (5%) had neither catheter removal nor anticoagulation. 100 (15%) patients experienced a recurrent VTE event. In the 579 patients who had catheter removal, the most common reason for catheter removal was the CRT [392 (68%)]. For subjects who received any anticoagulation (n = 512), total anticoagulation duration was not associated with VTE recurrence [1.000 (0.999–1.002)]. After adjustment patients treated with catheter removal only had an increased risk of VTE recurrence [2.50 (1.24–5.07)] and death [4.96 (2.47–9.97)]. Patients with no treatment had increased risk of death [16.81 (6.22–45.38)] and death after VTE recurrence [27.29 (3.13–238.13)].In this large, multicenter retrospective cohort, we found significant variability in the treatment of CRT in patients with hematologic malignancy. Treatment without anticoagulation was associated with recurrent VTE.

Risk factors for catheter related thrombosis in patients with intestinal failure on home parenteral nutrition

Risk factors for catheter related thrombosis in patients with intestinal failure on home parenteral nutrition

Catheter Related Thrombosis (CRT) in Hematologic Malignancy: A Retrospective Study of Venous Thromboembolism Management

Introduction: Central Venous Catheters (CVC) improve quality of life for patients with hematologic malignancy but long-term presence may result in CRT. Optimal treatment of CRT is uncertain. Here, we focus on a retrospective study of CRT in patients with hematologic malignancy to identify clinical features associated with increased risk for recurrent thrombosis. Methods: Demographic and management information of patients with CRT and hematologic malignancy was extracted from the medical record of a single academic medical center. Data was described using summary statistics. Nonparametric Cox proportional hazard models were utilized for thrombosis recurrence and bleeding occurrence. Unadjusted models were utilized for CRT treatment, type of anticoagulation, platelet count, and other factors. Results: 85 patients were included for analysis. Summary statistics are noted in Table 1. Median platelet count differed across initial treatment approach [Anticoagulation (AC): 177 (106.5- 662), Anticoagulation and Catheter Removal (AC+): 112 (61.75-304), Catheter Removal only 24 (20.25-35.5), No treatment 30.5 (16.75-10.8), p&lt;0.0001]. For CRT treatment, patients with AC+ have more than a 660 % chance of thrombosis recurrence compared to AC as reference group. This significant difference is also seen in the Kaplan Meir curves for CRT treat (log-rank p=0.0484), Figure 1. Of note, 15 patients treated with AC+ developed recurrent thrombosis, the majority of which (53%, 8/15) occurred within 100 days. Of these patients, 62% (5/8 patients) had at least 2 days delay in starting anticoagulation while no delays in starting anticoagulation were noted in patients who were primarily treated with AC. Of the 8 patients who received no therapy for CRT, 7/8 patients (87%) had noted brachial (peripheral deep). Discussion: Significant variability in management of CRT in patients with hematologic malignancy is noted. Platelet count at time of thrombosis may influence treatment decision. Our data indicate that treatment with anticoagulation is superior to treatment without anticoagulation. The difference in thrombosis recurrence seen in patients who received AC v. AC+ could potentially be explained by delays in starting AC in the latter group. Interestingly, patients who did not receive any therapy for CRT had no recurrence, which may be explained by the fact that the majority had peripheral deep thrombosis, which are less likely to have deep recurrences. In addition, type of anticoagulation used for treatment was notHowever, our data is limited by its population of single institutional patients and retrospective nature. Prospective, studies are needed to better delineate differences in outcomes. Disclosures Jaglal: NOVARTIS: Consultancy.

Analysis of risk factors associated central venous catheter-related thrombosis in patients undergoing abdominal operation

Objective: To analyze the risk factors of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery. Methods: A total of 125 patients (18-90 years, ASA Ⅰ-Ⅲ) scheduled for abdominal surgery underwent right internal jugular in our study. Ultrasound-guided central venous catheterization were carried out before surgery and Doppler ultrasound examination were conducted daily postoperatively until the catheter was removed. The patients were divided into thrombosis positive or negative group based on the Doppler ultrasound examinations. General clinical data of all patients including name, gender, age, BMI, preoperative Caprini score, bleeding, duration of operation and anesthesia, were also collected. D-dimer test was performed on the third postoperative day. Results: Of the 125 patients, 16(12.8%) were found to have catheter-related right internal jugular vein thrombosis. There were 16 cases (9 males and 7 females) in the thrombosis positive group, with an average age of (73±7) years old, body mass index (22.8±2.9) kg/m(2), and preoperative Caprini score (6.1±1.4).In the thrombosis negative group,among whom 72 were men and 37 were women. The average age of these patients was (66±11) years old, BMI was (22.6±2.9)kg/m(2), and preoperative Caprini score was (5.9±1.3).There was no statistical difference between the two groups regarding age, gender, BMI, preoperative Caprini score (P>0.05).The average operating time, anesthesia time, bleeding amount and D-dimer level on the third postoperative day were (189±46) min, (211±59) min, (288±96) ml,(3.4±1.6) mg/L in thethrombosis positive group, and (139±39) min, (171±46) min, (175±114) ml,(2.0±0.9) mg/L in the thrombosis negative group, respectively. Duration of surgery, bleeding amount and D-dimer level on the third postoperative day significantly affected the occurrence of catheter-related right internal jugular venous thrombosis (U=10.768, 359.000, 390.000, P<0.05), but no statistically significant differences in anesthesia time between the two groups.Logistic regression analysis screened out duration of surgery, bleeding amount and D-dimer level on the third postoperative day as risk factors for catheter-related right jugular venous thrombosis(OR=10.037, 1.011, 3.274, P<0.05). Conclusion: The high incidence of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery is closely related to intraoperative blood loss, operation time, D-dimer level on the third postoperative day and other factors.

Exploring the Risk Factors of Thrombosis and Bloodstream Infections in Peripherally Inserted Central Catheter (PICC) Patients

Objective: To analyze the risk factors of thrombosis and associated bloodstream infections in patients with a peripherally inserted central catheter (PICC). Method: A total of 711 patients who received a PICC in our hospital between February and December 2018 were enrolled in this study. Clinically relevant data were collected, including general information, medical histories, laboratory examinations, etc. The 711 patients underwent risk assessments for thrombosis and bloodstream infections to statistically analyze the relevant risk factors. Result: Thirty-three of the 711 patients developed thrombosis, which is a proportion of 4.64%. In addition, ten patients developed bloodstream infections at an infection rate of 1.41%. For patients with different catheter indwelling times, the difference in the proportion of bloodstream infections was statistically significant (p &lt; 0.05). Additionally, the analysis results showed that a difference in the vein-puncture site and the fibrinogen content is a direct risk factor for thrombosis. Moreover, PICC catheter indwelling is a risk factor for bloodstream infections. Conclusion: The nursing staff should adopt targeted and predictive graded-care interventions, including drug prevention and stratified care, to reduce catheter-related thrombosis in patients.

Wide Variation in Duration of Anticoagulation after Catheter-Related Thrombosis: A Venous Thromboembolism Network US Multicenter Retrospective Cohort Study

Background: Consensus guidelines recommend anticoagulation for 3 months in patients with upper extremity catheter-related thrombosis (CRT); however, recommendations are primarily extrapolated from data on provoked lower extremity thrombosis. Many patients with hematologic malignancy are treated with shorter durations of anticoagulation due to thrombocytopenia and other bleeding concerns. It is not known if duration of anticoagulation in patients with hematologic malignancy patients and CRT predicts risk of recurrence or hemorrhage.Methods: We performed a multicenter retrospective cohort study at five institutions through the Venous thromboEmbolism Network US (VENUS). Patients with hematologic malignancies with documented deep vein thrombosis associated with a catheter from 1/1/2010-12/31/2016 were identified using ICD-9 and ICD-10 diagnostic codes. Demographic information, management of the CRT, duration of anticoagulation, recurrent thrombosis, and bleeding during anticoagulation were extracted from the electronic medical record. Descriptive statistics will be used for demographic variables, disease and thrombosis characteristics, treatment type, duration of anticoagulation, recurrent thrombosis and bleeding outcomes. Non-parametric Kruskal Wallis were used to evaluate platelet count between treatment groups. Mann-Whitney U test was used to determine if duration of anticoagulation was associated with thrombosis recurrence.Results: Of the 379 patients included in the analysis, 151 (40%) had lymphoma, 143 (38%) had leukemia, 74 (20%) had plasma cell disorder, and 11 (3%) had myelodysplastic syndrome or a myeloproliferative neoplasm. 214 (56%) were male. Median follow-up duration was 274 days, and 134 (35%) patients died within the follow-up period. PICCs accounted for 254 (67%) of the CRT events, 74 (20%) of cases had tunneled catheters, and 50 (13%) had Port-a-Caths. The most proximal involvement of the thrombosis were as follows: 37 (10%) brachial vein, 81 (21%) axillary vein, 149 (39%) subclavian vein, 90 (24%) internal jugular vein, 5 (1%) brachiocephalic vein, and 14 (4%) superior vena cava. 252 (66%) patients were treated with anticoagulation and removal of the catheter, but 50 (13%) were treated with anticoagulation alone, 60 (16%) were treated with removal of the catheter only, and 17 (4%) did not have treatment for the CRT. Median platelet count at diagnosis differed between the treatment groups [anticoagulation: 145,000 (range 27,000-443,000); anticoagulation and catheter removal: 130,000 (6,000-963,000); catheter removal only: 42,000 (5,000-251,000); no treatment: 39,000 (6,000-423,000); p<0.0001]. For the 302 patients treated with anticoagulation, 229 (76%) were initially treated with low-molecular weight heparin, 31 (10%) were treated with unfractionated heparin, and 30 (10%) were bridged to warfarin. Median duration of anticoagulation therapy for the initial CRT was 56.5 days (range 1- 1,108 days). Among the 340 patients who had their catheter removed, 245 (72%) were removed due to the CRT, 56 (16%) due to completion of cancer therapy, 22 (6%) due to infection, and 17 (5%) for other reasons. Fifty-six patients (15%) experienced a recurrent VTE, and 7 (2%) patients experienced a second recurrent VTE event. Thirty-eight (10%) patients experienced bleeding during anticoagulation of which 19 (5%) were major hemorrhages. Duration of first anticoagulation did not differ between patients with and without recurrent thrombosis [with recurrence: median 67 days (range: 4-1,108), without recurrence: 54 (range: 1-453, p=0.32)].Conclusions: Significant variability remains in treatment of CRT in patients with hematologic malignancy. Despite the guidelines, many catheters are removed due to the thrombosis. Our results suggest that duration of anticoagulation is not associated with VTE recurrence. DisclosuresGaddh:Hema Biologics: Consultancy; Pharmacyclics LLC: Consultancy. Wang:Daiichi Sankyo: Consultancy, Other: Travel. Billett:Bayer: Consultancy; Janssen: Research Funding.

206P - Incidence of catheter-related thrombosis in patients with long-term indwelling central venous catheter who received chemotherapies for unresectable advanced digestive cancers

206P - Incidence of catheter-related thrombosis in patients with long-term indwelling central venous catheter who received chemotherapies for unresectable advanced digestive cancers

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Catheter-related thrombosis (CRT) occurs frequently during autologous hematopoietic cell transplantation (AHCT) and data regarding the incidence, risk factors, and management are understudied. We evaluated 789 consecutive patients with lymphoma and myeloma that underwent AHCT over 10 years (2006 to 2016) and detected the incidence of CRT was 6.3%; only 32% of CRT were symptomatic. The majority occurred within 100 days of AHCT (86%) and median time from tunneled line placement to CRT was 44 days (range, 11 to 89 days). Outcomes of these 50 patients with CRT were compared with age- and disease-matched AHCT control subjects to identify risk factors. History of prior venous thromboembolism (VTE) (20.9% versus 7.0%, P = .02) was the only significant risk factor. Treatment with low-molecular-weight heparin was tolerated with rare minor bleeding (4%), although CRT recurrence or extension (10%) and subsequent VTE (12%) were common. CRT did not impact on nonrelapse mortality or risk of relapse; 2-year progression-free survival was 55% in CRT cases versus 54% in control subjects (P = .42). CRT appears to be common in patients with lymphoma and myeloma undergoing AHCT and significantly contributes to morbidity. Further study to determine mitigating strategies and modify risk factors for CRT is warranted.

Incidence and outcomes of catheter related thrombosis (CRT) in patients with acute leukemia using a platelet-adjusted low molecular weight heparin regimen.

Patients with acute leukemia frequently develop catheter-related thrombosis (CRT) despite concurrent thrombocytopenia. The incidence, treatment and outcomes of this complication are poorly documented. We undertook this study todetermine the incidence of CRT in patients with acute leukemia and assess the safety and effectiveness of a treatment strategy using a platelet-adjusted low molecular weight heparin (LMWH) dosing protocol. Patients (18years and older) with newly diagnosed acute leukemia from January 2014 to December 2015 who received central venous catheters were included. The clinical data were reviewed up to 12months from acute leukemia diagnosis to capture objectively documented CRT events. The outcome events including recurrent venous thromboembolism (VTE), bleeding events, infectious or mechanical complications, and death were reported up to 3months from the time of CRT diagnosis. The incidence of CRT among 214 patients was 10.7% (23 patients) in the first 12 months after acute leukemia diagnosis. Among 18 patients who were treated with anticoagulation, 14 (78%) received reduced LMWH dosing due to concurrent thrombocytopenia. There were no recurrent VTE episodes, but 3 patients experienced bleeding events while on anticoagulation. Fifteen patients (83%) completed a minimum of 3 months anticoagulation. Twelve patients (52%) experienced an infectious complication, which was the main reason for catheter removal. Deaths occurred in 2 patients, related to underlying acute leukemia during 3 months period following CRT. Symptomatic CRT is frequent in patients with acute leukemia. Platelet-adjusted LMWH dosing may be effective and well tolerated despite thrombocytopenia.

Establishment of prophylactic enoxaparin dosing recommendations to achieve targeted anti-factor Xa concentrations in children with CHD.

Enoxaparin may be used to prevent central venous catheter-related thrombosis in patients with CHD. We aimed to determine whether current enoxaparin dosing regimens effectively achieve anti-factor Xa concentrations within prophylactic goal ranges in this patient population. We implemented a formal protocol aimed at reducing central venous catheter-related thrombosis in children with CHD in January, 2016. Standard empiric prophylactic enoxaparin dosing regimens were used - for example, 0.75 mg/kg/dose every 12 hours for patients <2 months of age and 0.5 mg/kg/dose every 12 hours for patients ⩾2 months of age - with anti-factor Xa goal range of 0.25-0.49 IU/ml. Patients <2 years of age who received enoxaparin and had at least one valid steady-state anti-factor Xa measurement between 25 January, 2016 and 31 August, 2016 were retrospectively reviewed. During the study period, 47 patients had 186 anti-factor Xa concentrations measured, of which 20 (11%) were above and 112 (60%) were below the prophylactic goal range. Anti-factor Xa concentrations within the goal range were ultimately achieved in 31 patients. Median dose required to achieve anti-factor Xa concentrations within the prophylactic range was 0.89 mg/kg/dose (25, 75%: 0.75, 1.11) for patients <2 months (n=23 patients) and 0.79 mg/kg/dose (25, 75%: 0.62, 1.11) for patients ⩾2 months (n=8 patients). Enoxaparin doses required to achieve prophylactic anti-factor Xa concentrations in young children with CHD were consistently higher than the currently recommended prophylactic dosing regimens. Further study is needed to determine whether dose titration to achieve prophylactic anti-factor Xa concentrations is effective in preventing central venous catheter-related thrombosis.

Biomarkers for Prediction of Central Venous Catheter Related-Thrombosis in Patients With Hematological Malignancies.

In a prospective setting, we aimed to find associations between biomarkers of the hemostatic system and the occurrence of central venous catheter (CVC)-related thrombosis in patients with hematological malignancies undergoing intensive chemotherapy. The study was conducted between July 2006 and August 2010 at the University Hospital Maastricht, the Netherlands. Consecutive adult patients with hematological malignancies who were going to receive a CVC for intensive chemotherapy were included. The primary end points were (a) symptomatic CVC-related thrombosis and (b) CVC-related infections. Blood samples were taken directly after catheterization, and easy to determine biomarkers (platelet count, leukocyte count, and hemoglobin level) in combination with blood group, factor VIII (FVIII), plasminogen activator inhibitor 1 (PAI-1), activated protein C (APC) resistance, and free protein S antigen were determined. Blood was collected and analyzed from 168 patients. The incidence of symptomatic CVC-related thrombosis was 9%. In univariate analysis, white blood cell count >10.6 × 109/L, mean FVIII activity, and PAI-1 >12.2 IU/mL were found to be associated with the development of symptomatic CVC-related thrombosis. Elevated leukocyte count, high PAI-1, and high FVIII were associated with an increased incidence of symptomatic CVC-related thrombosis. We hope in future that simple, easy to determine laboratory tests that reflect the hemostatic and fibrinolytic activity in combination with clinical parameters may help to identify hematological patients at highest risk of CVC-related thrombosis and help to tailor the management of thromboprophylaxis in hematological patients undergoing CVC placement.