Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study.
This prospective, observational and multicentre study assessed the incidence of, and risk factors for, symptomatic venous thrombotic complications after central venous catheter (CVC) positioning in patients with haematological malignancies. A total of 458 consecutive CVC insertions were registered in 416 patients (81.2% of whom had severe thrombocytopenia). Over the observation period (3 months or up to catheter removal), the incidence of events was: CVC-related deep vein thrombosis (DVT), 1.5%; lower limb DVT, 0.4%; pulmonary embolism (PE), 1.3%; fatal PE, 0.6%; CVC-related superficial thrombophlebitis, 3.9%; CVC-occlusion/malfunction of thrombotic origin, 6.1%; major arterial events, 1.1%. Severe bleeding and CVC-related infections were observed in 3.5% and 4.6% of cases respectively. A composite end point (any venous thromboembolism or superficial thrombophlebitis or CVC occlusion/malfunction) was defined in order to consider venous thrombotic events with a significant impact on clinical practice. With this criterion, the overall incidence was 12.0% (2.54 cases/1000 catheter days). No factor helped to predict venous thrombotic complications: only thrombocytopenia was associated with a weak trend for a reduced risk (odds ratio 0.52; 95% confidence interval 0.26-1.07). No severe bleeding was observed in those patients who received antithrombotic prophylaxis. This study shows that the impact on clinical practice of symptomatic CVC-related thrombotic complications is not negligible in patients with haematological malignancies.
Cortelezzi
Agostino
A
Department of Haematology and Bone Marrow Transplantation Unit, IRCCS Fondazione Ospedale Maggiore Policlinico and University of Milan, Milan, Italy.
Moia
Marco
M
Falanga
Anna
A
Pogliani
Enrico M
EM
Agnelli
Giancarlo
G
Bonizzoni
Erminio
E
Gussoni
Gualberto
G
Barbui
Tiziano
T
Mannucci
Pier Mannuccio
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology; D013921:Thrombocytopenia / Q000150:complications; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
D005343:Fibrinolytic Agents