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Observational Study
. 2020 Dec;50(12):1475-1482.
doi: 10.1111/imj.14780.

Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices

Marc L Ellis  1   2 , Satomi Okano  3 , Andrew McCann  4 , Angela McDowall  1 , Rosita Van Kuilenburg  1 , Alexandra L McCarthy  1   5 , Warren Joubert  1 , John Harper  6 , Mark Jones  3 , Peter Mollee  1   2
Affiliations
Observational Study

Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices

Marc L Ellis et al. Intern Med J. 2020 Dec.

Abstract

Background: Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks.

Aim: To review the incidence and risk factors for catheter-related thrombosis (CRT) in cancer patients with a CVAD.

Methods: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated.

Results: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9-170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39-0.84 for age 50-61 years, and HR 0.63; 95% CI 0.45-0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19-2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00-1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57-1.05; P = 0.10).

Conclusions: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.

Keywords: cancer; catheter; supportive care; thrombosis.

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