This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kuter, D. J. Search for Related Content PubMed PubMed Citation Articles by Kuter, D. J.

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence: David J. Kuter, M.D., D.Phil., Hematology/Oncology Unit, Massachusetts General Hospital, 100 Blossom Street, Boston, Massachusetts 02114, USA. Telephone: 617-726-3908; Fax: 617-724-3166; e-mail: kuter.david{at}MGH.harvard.edu

Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.

Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%–30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).

Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with low-molecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.

Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

Key Words. Thrombosis • Warfarin • Heparin • Catheter • DVT • Low molecular weight heparin

This article has been cited by other articles:

				S. P. Shivakumar, D. R. Anderson, and S. Couban Catheter-Associated Thrombosis in Patients With Malignancy J. Clin. Oncol., October 10, 2009; 27(29): 4858 - 4864. [Abstract] [Full Text] [PDF]

				P. Debourdeau, D. Kassab Chahmi, G. Le Gal, I. Kriegel, E. Desruennes, M.-C. Douard, I. Elalamy, G. Meyer, P. Mismetti, M. Pavic, et al. 2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the working group Ann. Onc., September 1, 2009; 20(9): 1459 - 1471. [Abstract] [Full Text] [PDF]

				M. Gallieni, M. Pittiruti, and R. Biffi Vascular Access in Oncology Patients CA Cancer J Clin, November 1, 2008; 58(6): 323 - 346. [Abstract] [Full Text] [PDF]

				R. DeChicco, D. L. Seidner, C. Brun, E. Steiger, J. Stafford, and R. Lopez Tip Position of Long-Term Central Venous Access Devices Used for Parenteral Nutrition JPEN J Parenter Enteral Nutr, September 1, 2007; 31(5): 382 - 387. [Abstract] [Full Text] [PDF]

				C. Lainesse, S. R. Boysen, and M. Y. Doucet One-step method for catheterising the jugular vein of cats to enable repeated blood sampling Vet Rec., August 18, 2007; 161(7): 221 - 225. [Abstract] [Full Text] [PDF]

				A. Chan, A. Iannucci, and W. E Dager Systemic Anticoagulant Prophylaxis for Central Catheter-Associated Venous Thrombosis in Cancer Patients Ann. Pharmacother., April 1, 2007; 41(4): 635 - 641. [Abstract] [Full Text] [PDF]

				M. Adess, R. Eisner, S. Nand, J. Godwin, H. L. Messmore Jr, and W. H. Wehrmacher Thromboembolism in Cancer Patients: Pathogenesis and Treatment Clinical and Applied Thrombosis/Hemostasis, July 1, 2006; 12(3): 254 - 266. [Abstract] [PDF]

				C. Twelves, S. Gollins, R. Grieve, and L. Samuel A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer Ann. Onc., February 1, 2006; 17(2): 239 - 245. [Abstract] [Full Text] [PDF]

				M. J. Sands Vascular Access in the Adult Home Infusion Patient JPEN J Parenter Enteral Nutr, January 1, 2006; 30(1_suppl): S57 - S64. [Abstract] [Full Text] [PDF]

				J. A. Kerner Jr, M. G. Garcia-Careaga, A. A. Fisher, and R. L. Poole Treatment of Catheter Occlusion in Pediatric Patients JPEN J Parenter Enteral Nutr, January 1, 2006; 30(1_suppl): S73 - S81. [Abstract] [Full Text] [PDF]

				M. Magagnoli, L. Castagna, G. Masci, and A. Santoro Low-Dose Warfarin Prophylaxis for Catheter-Associated Thrombosis in Cancer Patients. Can It Be Safely Associated with 5-Fluorouracil-Based Chemotherapy? Oncologist, September 1, 2004; 9(5): 594 - 595. [Full Text] [PDF]