Highlights
- •LMWH seems to be a safe and effective to manage catheter associated UEDVT.
- •LMWH can safely be discontinued when cancer is in remission and catheter is removed.
- •Patients with active cancer have a high risk of recurrent VTE.
Abstract
Introduction
Data on efficacy and safety of using low molecular weight heparin in cancer patients
with catheter-related upper extremity deep vein thrombosis is scarce and the risk
of recurrent venous thromboembolism after discontinuation of anticoagulation is unknown.
Material and methods
We conducted a retrospective cohort study including consecutive cancer outpatients
assessed for the management of symptomatic central venous catheter-associated proximal
upper extremity deep vein thrombosis.
Results
Of 99 included patients, 89 were treated with one month of full therapeutic weight-adjusted
dose of low molecular weight heparin followed by an intermediate dose. Median duration
of anticoagulation was 124 days (range 40 to 1849). No recurrent venous thromboembolism and two major bleeding
episodes occurred during the first 3 months of treatment. Eighty patients were followed-up after anticoagulation discontinuation
for a median of 632 days (range 6 to 2495). Central venous line was pulled in all patients in remission
and in 26 of the 29 patients (89.6%) with active cancer. Five recurrences were observed
during follow-up. The cumulative probability of recurrent venous thromboembolism was
higher in patients whose cancer was active at the time of anticoagulation discontinuation
as compared with those in remission (22.2% (95% CI: 0 to 40.6) vs. 2.3% (95% CI: 0 to 6.7)).
Conclusion
The risk of venous thromboembolism recurrence in patients whose central venous catheter
has been pulled out and cancer is in remission appears low following anticoagulation
discontinuation and after a minimum of 3 months of full/intermediate dose.
Keywords
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References
- Diagnosis and management of upper extremity deep-vein thrombosis in adults.Thromb Haemost. 2012; 108: 1097-1108
- Venous thromboembolism associated with long-term use of central venous catheters in cancer patients.J Clin Oncol. 2003; 21: 3665-3675
- International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer.J Thromb Haemost. 2013; 11: 71-80
- Catheter-associated deep vein thrombosis of the upper extremity in cancer patients: guidance from the SSC of the ISTH.J Thromb Haemost. 2014; 12: 796-800
- Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer.Cochrane Database Syst Rev. 2011; : CD006650
- A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study).J Thromb Haemost. 2007; 5: 1650-1653
- Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e419S-e494S
- Venous thromboembolism in cancer clinical trials: recommendation for standardized reporting and analysis.J Thromb Haemost. 2012; 10: 2599-2601
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost. 2005; 3: 692-694
- Development and validation of a predictive model for chemotherapy-associated thrombosis.Blood. 2008; 111: 4902-4907
- Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer.Am J Med. 2014; 127: 82-86
Article info
Publication history
Published online: December 01, 2014
Accepted:
November 25,
2014
Received in revised form:
November 24,
2014
Received:
October 7,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
