title: Incidence of ultrasound-detected asymptomatic long-term central vein catheter-related thrombosis and fibrin sheath in cancer patients.
abstract: BACKGROUND
  Most central venous catheter (CVC)-related deep vein thromboses (DVT) are asymptomatic and their incidence and clinical relevance are still under debate. Data on CVC-related fibrin sheaths are scarce. We investigated the incidence of asymptomatic DVT and fibrin sheaths in cancer patients with long-term CVC implantation who underwent Doppler ultrasound surveillance at 1, 6, and 12 months after implantation. Effects of low-weight molecular heparin (LWMH) therapy on DVT and fibrin sheaths were also analyzed.
  
  
  METHODS
  This prospective study was performed on a large cohort (n = 400) of patients with cancer aged >18 requiring long-term CVC implantation for chemotherapy infusion. CVC was implanted by a trained qualified staff, according to standardized protocol in a specific surgery. Patients underwent ultrasound examination at 1 and 6 months after CVC implantation to detect 'early' (1 month) and 'late' (6 months) asymptomatic DVT or fibrin sheaths incidence. Sixty-nine patients underwent US examination also 12 months after CVC implantation.
  
  
  RESULTS
  The incidence of CVC-related thrombosis was 0.10 events per 1000 catheter days. Anticoagulation therapy with LWMH resolved 50% of DVT, but no CVC needed removing. Incidence of new onset fibrin sheaths was 0.71 events per 1000 catheter days. Fibrin sheaths resolution occurred independently of LWMH therapy.
  
  
  CONCLUSIONS
  The incidence of asymptomatic DVT in our patients with long-term CVC is very low and does not represent per se an indication for removal of functioning CVC in patients with cancer. Fibrin sheaths are frequent (13%) and never associated with CVC dysfunction.
  
  
  CONCLUSIONS
  Asymptomatic DVT and fibrin sheaths do not represent per se an indication for removal of functioning CVC in cancer patients who need central vein access.
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Boddi
authors.affiliation: Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Villa
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Antoniis
authors.affiliation: Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Fanti
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spinelli
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Savino
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.|Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pelagatti
mesh_terms: D000368:Aged; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000628:therapy*; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism
chemical_list: D005337:Fibrin
keywords: central venous catheters; heparin; neoplasms; ultrasonography; venous thrombosis