title: Risk factors for upper limb deep vein thrombosis associated with the use of central vein catheter in cancer patients.
abstract: Deep vein thrombosis of upper limb is a common complication of CVC in patients with cancer. In these patients the risk factors for CVC-related thrombosis are not completely defined. The purpose of this study was to identify the risk factors for CVC-related thrombosis in patients included in a randomized, double-blind, placebo-controlled study aimed at assessing the efficacy and safety of enoxaparin for the prophylaxis of CVC-related thrombosis. CVC-related thrombosis was screened by mandatory venography after 6 weeks of study treatment. A number of patient baseline characteristics were assessed as potential risk factors for CVC-related deep vein thrombosis. Crude associations between risk factors and clinical outcomes were assessed by chi(2) test or Fisher's exact test. Multiple logistic regression analysis was used to identify independent risk factors. A CVC-related thrombosis was found in 50 out of 310 patients (16.1%). At multiple logistic regression analysis, CVC tip misplaced in the upper half of superior vena cava (OR 4.05, 95%CI 1.64-10.02), left-sided CVC insertion (OR 2.29, 95%CI 1.01-5.51) and chest radiotherapy (OR 7.01, 95%CI 1.42-34.66) were independent risk factors for thrombosis. In addition to these risk factors, the presence of distant metastases (OR 9.36, 95%CI 1.53-57.05) increased the risk of thrombosis in patients who received placebo. An inadequate position of the CVC tip, left-sided CVC insertion and chest radiotherapy are independent risk factors for CVC-related thrombosis in cancer patients. Patients with distant metastases have an increased risk for thrombosis in absence of antithrombotic prophylaxis.
authors.affiliation: Dipartimento di Medicina Interna, Università di Perugia, Perugia, Italy. mverso@libero.it
authors.forename: Melina
authors.initials: M
authors.lastname: Verso
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.forename: Mario
authors.initials: M
authors.lastname: Bazzan
authors.forename: Antonio
authors.initials: A
authors.lastname: Lazzaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Paoletti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Stefano
authors.initials: S
authors.lastname: Mosca
authors.forename: Sergio
authors.initials: S
authors.lastname: Bertoglio
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D016001:Confidence Intervals; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D017984:Enoxaparin; D005343:Fibrinolytic Agents