The impact of antithrombotic prophylaxis on infectious complications in cancer patients with central venous catheters: an observational study.
Infections in cancer patients after implantation of a central venous device (CVD) are not infrequent and are potentially serious. The possibility of limiting this complication with antithrombotic drugs is still debated. For this observational study, we recorded the routine management of CVD in cancer patients in 18 oncology centers in Lombardy (northern Italy), assessing the effect of antithrombotic prophylaxis on catheter-related infections. Out of 1410 patients enrolled, 451 received antithrombotic prophylaxis continuously after implantation of the central line. During a median follow-up of 30 months, 57 catheter-related infections were reported in the 1390 patients seen at least once at follow-up visits (4.1% of the whole series), giving an overall incidence of 0.10 infections per 1000 catheter days. This complication was significantly more frequent among patients with an indwelling central venous catheter, or peripherally inserted catheter, than among those with a port device, and the group not given antithrombotic prophylaxis had 0.14 infective complications/1000 CVD days compared with 0.05/1000 CVD days (odds ratio 2.4; 95% confidence interval 1.7-5.0) for those treated. Antithrombotic prophylaxis protected against infections at the catheter exit site and track but not against systemic infections. Confirming earlier evidence, this study found a reduction in catheter-related infections in patients given antithrombotic prophylaxis. However, this reduction, reflecting local infections, seems unlikely to be one of the mechanisms explaining the lower mortality among our patients treated with anticoagulants.
Department of Oncology, Desio Hospital, Azienda Ospedaliera Ospedale Civile di Vimercate, Milan, Italy. danielefagnani@libero.it
Daniele
D
Fagnani
Alessandro
A
Bertolini
Laura
L
Catena
Maurizio
M
Tomirotti
Marilena
M
Visini
Adriano
A
Alatri
Alberto
A
De Paoli
Gian Marco
GM
Aondio
Massimo
M
Milani
Guido
G
Arpaia
Claudio
C
Cimminiello
Roberto
R
Franchi
Camillo
C
Porta
Palma
P
Pugliese
Karen
K
Borgonovo
Marilina
M
Duro
Antonio
A
Ardizzoia
Virginio
V
Filipazzi
Luciano
L
Isa
Claudio
C
Vergani
Monica
M
Carpenedo
Pierluigi
P
Viale
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000517:prevention & control*; D012044:Regression Analysis; D016896:Treatment Outcome; D014859:Warfarin / Q000494:pharmacology*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin