title: A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study).
abstract: BACKGROUND
  Central venous catheters in patients with cancer are associated with development of deep vein thrombosis (DVT); however, there is no accepted standard treatment.
  
  
  OBJECTIVE
  To assess the safety and effectiveness of a management strategy for central venous catheter-related DVT in cancer patients consisting of dalteparin and warfarin without the need for line removal.
  
  
  METHODS
  Patients older than 18 years of age with an active malignancy and who had symptomatic, acute, objectively documented UEDVT were eligible. Patients were treated with dalteparin 200 IU kg(-1) per day for 5-7 days and warfarin with a target International Normalized Ratio of 2.0-3.0. Patients were followed for 3 months for recurrent venous thromboembolism, major hemorrhage and survival of the central venous catheter.
  
  
  RESULTS
  There were 74 patients (48 males). The average age was 58 years. There were no episodes of recurrent venous thromboembolism and three (4%) major bleeds. No lines were removed because of infusion failure or recurrence/extension of DVT.
  
  
  CONCLUSIONS
  Treatment of UEDVTs secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of the DVT.
authors.affiliation: Department of Medicine, Victoria Hospital, London, ON, Canada. michael.kovacs@lhsc.on.ca
authors.forename: M J
authors.initials: MJ
authors.lastname: Kovacs
authors.forename: S R
authors.initials: SR
authors.lastname: Kahn
authors.forename: M
authors.initials: M
authors.lastname: Rodger
authors.forename: D R
authors.initials: DR
authors.lastname: Anderson
authors.forename: R
authors.initials: R
authors.lastname: Andreou
authors.forename: J E
authors.initials: JE
authors.lastname: Mangel
authors.forename: B
authors.initials: B
authors.lastname: Morrow
authors.forename: A M
authors.initials: AM
authors.lastname: Clement
authors.forename: P S
authors.initials: PS
authors.lastname: Wells
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000379:methods*; D015331:Cohort Studies; D017985:Dalteparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D010865:Pilot Projects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D017985:Dalteparin