Treatment of catheter-related deep vein thrombosis in patients with acute leukemia with anticoagulation.
Patients with acute leukemia develop venous thrombosis (VT) related to central venous catheters (CVCs). Anticoagulation (AC) in these patients who are thrombocytopenic and often coagulopathic is challenging. To evaluate the safety and efficacy of AC in treating CVC-related VT, we retrospectively compared outcomes of patients with acute leukemia who were treated or not with AC during induction chemotherapy and post-discharge. Twenty-one patients with CVC-related VT received AC, 14 did not. VT resolved in 80% of patients in the AC group (similarly with low-dose and high-dose enoxaparin) and 45% in the non-AC group (p = 0.11). Fourteen (67%) patients in the AC group are alive (median survival not reached), compared to four patients (29%) in the non-AC group (median survival 9 months) (p = 0.015) with a hazard ratio (HR) of 0.32 (95% confidence interval: 0.12-0.85) in favor of AC. HR remained < 1 after adjustments for leukemia type and cytogenetics. Bleeding (< grade 4) occurred in five and one patients in the AC vs. non-AC groups, respectively (p = 0.37).
Greenebaum Cancer Center.
Nora
N
Oliver
Briana
B
Short
Mya
M
Thein
Vu H
VH
Duong
Michael L
ML
Tidwell
Edward A
EA
Sausville
Maria R
MR
Baer
Farin
F
Kamangar
Ashkan
A
Emadi
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants
Myeloid leukemias and dysplasias; clinical results; pharmacotherapeutics