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In Reply:

Henderson Research Centre, Hamilton, Ontario, Canada

In their nested case-control study, Mandala et al demonstrated an association between the presence of the factor V Leiden mutation and catheter-related thrombosis.¹ I had the pleasure of discussing this research at a poster discussion session at the 2004 Annual Meeting of the American Society of Clinical Oncology. An association between factor V Leiden and central vein catheter thrombosis in cancer patients has also been reported in studies by Jansen et al² and van Rooden et al,³ but not in a study by Tesselaar et al.⁴

I would agree with the conclusion of Mandala et al that it is not cost effective to screen all cancer patients with central vein catheters for hereditary thrombophilia. Their suggestion to offer testing to patients with a history of venous thromboembolism (VTE) seems reasonable, but in cancer patients with a history of unprovoked (idiopathic) VTE, irrespective of the presence or absence factor V Leiden mutation, primary antithrombotic prevention can be considered. Finally they suggest that in a factor V Leiden carrier with a positive history of VTE, an alternative approach would be to avoid chemotherapy given by continuous infusion, and thereby the need for a central vein catheter. It is likely that such a cancer patient would be at increased risk of VTE related to any form of chemotherapy.⁵

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Mandala 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[Abstract/Free Full Text]

2. Jansen FH, van der Straaten HM, Roest M, et al: Elevated levels of D-dimer and fragment 1&2 upon central venous catheter insertion and factor V Leiden predict subclavian vein thrombosis. Haematologica 90:499-504, 2005[Abstract/Free Full Text]

3. van Rooden CJ, Rosendaal FR, Meinders AE, et al: The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis. Haematologica 89:201-206, 2004[Abstract/Free Full Text]

4. Tesselaar MET, Ouwerkerk J, Nooy MA, et al: Risk factors for thrombosis in cancer patients. Eur J Cancer 40:2253-2259, 2004

5. Kearon C: Long-term management of patients after venous thromboembolism. Circulation 110:I10-I18, 2004 (suppl 1)

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