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Incidence, Risk Factors, and Outcomes of Catheter-Related Thrombosis in Adult Patients With Cancer

Agnes Y.Y. Lee, Mark N. Levine, Gregory Butler, Carolyn Webb, Lorrie Costantini, Chushu Gu, Jim A. Julian

From the Departments of Medicine, Clinical Epidemiology & Biostatistics, and Radiology, McMaster University; and the Henderson Research Centre; and the Hamilton Health Sciences, Hamilton, Ontario, Canada

Address reprint requests to Agnes Y.Y. Lee, MD, Hamilton Health Sciences Henderson Hospital, 711 Concession St, Hamilton, ON L8V 1C3 Canada; e-mail: alee{at}mcmaster.ca

PURPOSE: Thrombosis of long-term central venous catheters (CVC) is a serious complication that causes morbidity and interrupts the infusion of chemotherapy, intravenous medication, and blood products. We performed a prospective study to examine the incidence, risk factors, and long-term complications of symptomatic catheter-related thrombosis (CRT) in adults with cancer.

PATIENTS AND METHODS: Consecutive patients with cancer, undergoing insertion of a CVC, were enrolled and prospectively followed while their catheter remained in place plus 4 subsequent weeks or a maximum of 52 weeks, whichever came first. Patients with symptomatic CRT were followed for an additional 52 weeks from the date of CRT diagnosis. The end points were symptomatic CRT, symptomatic pulmonary embolism (PE), postphlebitic syndrome, and catheter life span.

RESULTS: Over 76,713 patient-days of follow-up, 19 of 444 patients (4.3%) had symptomatic CRT in 19 of 500 catheters (0.3 per 1,000 catheter-days). The median time to CRT was 30 days and the median catheter life span was 88 days. Significant baseline risk factors for CRT were: more than one insertion attempt (odds ratio [OR] = 5.5; 95% CI, 1.2 to 24.6; P = .03); ovarian cancer (OR = 4.8; 95% CI, 1.5 to 15.1; P = .01); and previous CVC insertion (OR = 3.8; 95% CI, 1.4 to 10.4; P = .01). Nine of the 19 CRT patients were treated with anticoagulants alone, eight patients were treated with anticoagulants and catheter removal, while two patients did not receive anticoagulation. None had recurrent CRT or symptomatic PE. Postphlebitic symptoms were infrequent.

CONCLUSION: In adults with cancer, the incidence of symptomatic CRT is low and long-term complications are uncommon.

Supported by the Hamilton Regional Cancer Centre Foundation, Juravinski Cancer Centre, Hamilton, Ontario, Canada.

Presented in part at the American Society of Hematology Annual Meeting, San Diego, CA, December 4-7, 2004.

Agnes Y.Y. Lee, MD, is a recipient of a New Investigator Award from the Canadian Institutes of Health Research Research and Development Program.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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