A shortened activated partial thromboplastin time predicts the risk of catheter-associated venous thrombosis in cancer patients.
BACKGROUND
Hypercoagulability due to high coagulation factor levels resulting from host inflammatory response to cancer contributes to an increased risk of venous thromboembolism (VTE) in cancer patients. Central venous catheters (CVCs) further heighten this risk. Activated partial thromboplastin time (aPTT) can be used to broadly screen for elevated levels of relevant coagulation factors. Our objective was to determine if a shortened aPTT ratio (coagulation time of test- to- reference plasma) was a predictor of CVC-associated VTE in cancer patients.


METHODS
We performed a retrospective case-control study on cancer patients undergoing tunneled CVC insertion at our center from 1999 to 2006 and identified 40 patients who had CVC-associated VTE. VTE was confirmed with color duplex ultrasonography or computed tomography scan. For each case, we obtained 5 controls that had the same cancer diagnosis and were matched on the following factors: age, chemotherapy, hormone therapy (if applicable), tobacco use, TNM staging and year of diagnosis. All patients had aPTT testing within 30 days prior to surgery. We compared aPTT and aPTT ratio between cases and controls using Wilcoxon two sample test.


RESULTS
aPTT ratio was significantly shorter in patients with CVC-related VTE as compared to controls [0.86 (95% confidence interval (CI) 0.78, 0.94) vs. 0.98 (0.94, 1.01), p=0.0003]. Mean aPTT was also significantly shorter. [25.6 seconds (95% CI 23.2, 27.9) vs. 28.1 (26.9, 29.3), p=0.001] aPTT ratios of the controls tended to spread across larger aPTT ratio values whereas those of cases tended to clustered around the mean.


CONCLUSIONS
Cancer patients undergoing catheter placement who develop CVC-associated VTE have a shorter aPTT and aPTT ratio than those who do not develop VTE. aPTT, a simple and inexpensive test might be useful as a predictor of CVC-associated VTE risk in cancer patients.
Department of Surgery, City of Hope Medical Center, Duarte, California 91010.
Maheswari
M
Senthil
Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, California 90033.
Preeti
P
Chaudhary
Division of Biostatistics, City of Hope Medical Center, Duarte, California 91010.
David D
DD
Smith
Division of Biostatistics, City of Hope Medical Center, Duarte, California 91010.
Patrick E
PE
Ventura
Division of Biostatistics, City of Hope Medical Center, Duarte, California 91010.
Paul H
PH
Frankel
Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, California 90033.
Vinod
V
Pullarkat
Department of Surgery, City of Hope Medical Center, Duarte, California 91010. Electronic address: VTrisal@coh.org.
Vijay
V
Trisal
D000328:Adult; D016022:Case-Control Studies; D062905:Central Venous Catheters / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000097:blood* / Q000473:pathology*; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000097:blood* / Q000209:etiology
Activated partial thromboplastin time; Cancer; Central venous catheters; Factor VIII; Fibrinogen; Venous thromboembolism