title: Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition.
abstract: BACKGROUND
  There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN.
  
  
  METHODS
  Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement.
  
  
  RESULTS
  One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000).
  
  
  CONCLUSIONS
  High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.
authors.affiliation: Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Berea-Baltierra
authors.affiliation: Department of Pediatrics, Pediatric Hospital, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Rivas-Ruiz
authors.affiliation: Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
authors.forename: Elpidia
authors.initials: E
authors.lastname: Vela-Martinez
authors.affiliation: Postgraduate Unit, Escuela Superior de Medicina, Instituto Politecnico Nacional, Mexico City, Mexico.
authors.forename: Maria de la Luz
authors.initials: Mde L
authors.lastname: Sevilla-Gonzalez
authors.affiliation: Centro de Adiestramiento en Investigacion Clinica, Coordinacionde Investigacion en Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
authors.forename: Juan Osvaldo
authors.initials: JO
authors.lastname: Talavera-Pina
authors.affiliation: Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
authors.forename: Elena
authors.initials: E
authors.lastname: Valencia-Jimenez
authors.affiliation: Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
authors.forename: Irene
authors.initials: I
authors.lastname: Perez-Franco
authors.affiliation: Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
authors.forename: Laura
authors.initials: L
authors.lastname: Escobedo-Hernandez
keywords: Cancer; Parenteral nutrition; Risk factors; Subclavian vein thrombosis
references.citation: Chest. 1998 Jul;114(1):207-13
references.pmid: 9674471
references.citation: Gynecol Oncol. 1993 Jun;49(3):354-8
references.pmid: 8314538
references.citation: Cancer. 1983 Nov 1;52(9):1586-9
references.pmid: 6616416
references.citation: Thromb Res. 1997 Apr 15;86(2):101-13
references.pmid: 9175232
references.citation: Eur J Cancer. 1990;26(9):950-3
references.pmid: 2149020
references.citation: QJM. 2003 Oct;96(10):711-29
references.pmid: 14500858
references.citation: Oncologist. 2004;9(2):207-16
references.pmid: 15047925
references.citation: Haemostasis. 1997 May-Jun;27(3):112-8
references.pmid: 9306127
references.citation: Tumori. 2010 Sep-Oct;96(5):690-4
references.pmid: 21302613
references.citation: J Infect Dis. 1998 Mar;177(3):793-5
references.pmid: 9498467
references.citation: JPEN J Parenter Enteral Nutr. 1981 May-Jun;5(3):240-2
references.pmid: 6788974
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004084
references.pmid: 17636746
references.citation: J Ultrasound Med. 2005 Jun;24(6):829-38; quiz 839-40
references.pmid: 15914687
references.citation: Oncology. 1991;48(4):297-300
references.pmid: 1891171
references.citation: Arch Intern Med. 2004 May 10;164(9):963-8
references.pmid: 15136304
references.citation: Lancet Oncol. 2002 Jan;3(1):27-34
references.pmid: 11908507
references.citation: Blood Coagul Fibrinolysis. 1993 Apr;4(2):249-54
references.pmid: 8388741
references.citation: Cancer. 1992 May 1;69(9):2289-92
references.pmid: 1562974
references.citation: Eur J Radiol. 1995 Jul;20(2):108-11
references.pmid: 7588863
references.citation: Clin Radiol. 1995 Oct;50(10):687-9
references.pmid: 7586960
references.citation: Intern Emerg Med. 2008 Jun;3(2):117-22
references.pmid: 18317868