Venous thromboembolism in colorectal cancer patients with central venous catheters for 5-FU infusion-based pharmacokinetic modulating chemotherapy.
Colorectal cancer patients with central venous catheters (CVC) for pharmacokinetic modulating chemotherapy (PMC) have a substantial risk of venous thromboembolism (VTE). PMC, designed as a hybrid of lower metronomic and higher shorter plasma 5-FU concentrations, has been clinically successful. To determine the effectiveness and safety of D-dimer tests and multidetector-row CT (MDCT) for diagnosis in cancer patients with suspected VTE, we carried out a clinical outcome study on PMC outpatients. Patients received a D-dimer test before and after commencing the PMC regimen. MDCT was performed additionally if the D-dimer test appeared positive or showed signs of VTE. When CT results were positive for thromboembolism, anticoagulation was started. The overall prevalence of VTE in PMC patients was 2.0% (7 of 350 patients). In this study, 34 out of 102 colorectal cancer patients gave a positive D-dimer test (33.3%). CT identified venous thrombi in 2 of the 102 patients (2.0%), mural thrombosis on catheterized veins in another 3 patients (2.9%), and endothelial hyperplasia on catheterized veins in 8 patients (7.8%). The catheters of these patients did not show any significant abnormalities. Patients with negative D-dimer tests showed no signs or symptoms of VTE. In colorectal cancer patients receiving continuous 5-FU infusion via CVC, a D-dimer test can be safely used as the primary diagnostic test for ruling out VTE. We suggest 7.0 microg/ml as the D-dimer cut-off value. Thromboprophylaxis should be considered in the patients showing values >7.0 microg/ml.
Yoshikawa
Reigetsu
R
Second Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. yosikr2s@hyo-med.ac.jp
Yanagi
Hidenori
H
Noda
Masafumi
M
Ikeuchi
Hiroki
H
Nakano
Hiroki
H
Gega
Makoto
M
Tsukamoto
Kiyoshi
K
Oshima
Tsutomu
T
Inoue
Takashi
T
Fujiwara
Yoshinori
Y
Shoji
Yasutsugu
Y
Sakaki
Takatoshi
T
Higasa
Satoshi
S
Hashimoto-Tamaoki
Tomoko
T
Yamamura
Takehira
T
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000493:pharmacokinetics; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D002405:Catheterization, Central Venous; D015179:Colorectal Neoplasms / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000096:biosynthesis; D005472:Fluorouracil / Q000009:adverse effects / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis
D000925:Anticoagulants; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005472:Fluorouracil