|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 23, No 28 (October 1), 2005: pp. 7243-7244 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.02.1816
Prophylaxis for Venous Thromboembolism in Cancer Patients With a Central Vein Catheter: New Tones for an Old SongClinical Pharmacology & New Drugs Unit, Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy To the Editor: We found interesting articles and related editorials on thromboprophylaxis of catheter-associated thrombosis in cancer patients, published ahead of print in the Journal of Clinical Oncology on March 15, 2005.1-3 The two studies, while well designed, failed to demonstrate a beneficial effect of enoxaparin or warfarin in prophylaxis of catheter-related thrombosis. Dr Levine's editorial3 concluded that, given the current evidence, routine prophylaxis should not be recommended in this broad group of patients. Despite such a straightforward conclusion, we believe that physicians' compliance for primary prevention of venous thromboembolism (VTE) should be implemented in patients considered at high risk of VTE (eg, metastatic cancer, presence of long-term central venous catheters, infusional chemotherapy). We conducted a study aimed at identifying features that would help to predict thrombotic complications in patients with catheter-related VTE,4 and analyzed the influence of the prothrombotic gene mutation factor V G1691A (factor V Leiden) and prothrombin G20210A on the risk of a first episode of catheter-related VTE in a group of patients with breast cancer treated with chemotherapy. The study cohort consisted of 300 consecutive patients with locally advanced or metastatic breast cancer treated with fluorouracil-based chemotherapy, administered continuously through a totally implanted access port. Twenty-five patients with catheter-related VTE and 50 patients (controls) without VTE matched with cases for age, identical chemotherapy, stage of disease, and prognostic features were selected. The G1691A factor V and G20210A prothrombin mutation genotypes were analyzed. The conclusion was that in patients who develop catheter-related VTE for advanced breast cancer, the prevalence of factor V Leiden was five times higher than in those without thrombosis, giving a six-fold relative risk. In particular, five cases (20%; 95% CI, 9% to 39%) and 2 controls (4%; 95% CI, 1% to 14%) were heterozygous carriers of G1691A factor V (P = .04). The identification of a subgroup of patients with cancer at high risk for VTE might be reasonable strategies for proper care to either avoid medical devices that enhance the risk of thrombosis or to consider the implementation of primary antithrombotic prophylaxis. We do not advise genetic testing for all patients with cancer receiving chemotherapy through a totally implantable central catheter, because the number of patients to be tested to avoid few episodes of VTE is likely to confer little cost effectiveness to this strategy. Based on our study we suggest that factor V Leiden carriers, identified among cancer patients who had a positive history of VTE (even when not cancer related), are likely to benefit from an antithrombotic prophylaxis or from an alternative cytotoxic treatment selection, which does not require continuous infusion and the implantation of central vein catheter. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Verso M, Agnelli G, Bertoglio S, et al: Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: A doubleblind, placebo-controlled, randomized study in cancer patients. J Clin Oncol 23:4057-4062, 2005
2. Couban S, Goodyear M, Burnell M, et al: Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter–associated thrombosis in patients with cancer. J Clin Oncol 23:4063-4069, 2005
3. Levine M, Kakkar AK: Catheter-associated thrombosis: Thromboprophylaxis or not? J Clin Oncol 23:4006-4008, 2005
4. Mandalà M, Curigliano G, Bucciarelli P, et al: Factor V Leiden and G20210A prothrombin mutation and the risk of subclavian vein thrombosis in patients with breast cancer and a central venous catheter. Ann Oncol 15:590-593, 2004
Related Reply
This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
