title: A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis.
abstract: BACKGROUND
  Few studies have investigated the treatment and the outcomes of patients with catheter-related thrombosis (CRT).
  
  
  METHODS
  The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of consecutive patients with objectively confirmed venous thromboembolism (VTE). We analyzed the characteristics, treatment, and outcomes of patients with CRT.
  
  
  RESULTS
  Of 558 patients with CRT, 45 (8%) presented with a pulmonary embolism (PE) concomitantly. More patients had central line-associated thrombosis compared with port systems, but catheter type did not influence the risk of presenting with a PE. Patients with only CRT were more often prescribed low-molecular-weight heparin for the duration of their anticoagulant treatment compared with patients presenting with concomitant PE. VTE recurrences and major bleeding events occurred frequently during treatment with anticoagulation (7 per 100 patient-years and 8.9 per 100 patient years, respectively). The rates of fatal PE recurrences (1.85 per 100 patient-years) and fatal bleeding (2.32 per 100 patient-years) were similar. Patients with an additional transient risk factor for VTE had the lowest risk for VTE recurrences (odds ratio [OR], 0.07; 90% confidence interval [CI], 0.01-0.45) compared with patients with CRT and no additional transient risk factors. PE at presentation increased the risk of recurrent thrombosis by 2.4 times. Renal insufficiency was also an independent predictor of recurrent thrombosis (OR, 3.93; 90% CI, 2.0-7.7). The odds of recurrent thrombosis was decreased by 77% in patients who received anticoagulation therapy for >90 days compared with patients with a shorter treatment (OR, 0.23; 90% CI, 0.1-0.56).
  
  
  CONCLUSIONS
  Concomitant PE occurs less frequently in CRT than lower extremity deep venous thrombosis, but it is associated with a worse outcome. CRT occurs in high-risk patients, and duration of anticoagulation must be predicated on balancing these risks.
authors.affiliation: BloodCenter of Wisconsin, Department of Medicine/Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisc. Electronic address: Lisa.baumannkreuziger@bcw.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Baumann Kreuziger
authors.affiliation: Department of Nursing/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Chicago, Ill.
authors.forename: Lauren
authors.initials: L
authors.lastname: Cote
authors.affiliation: Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.affiliation: Department of Anesthesia/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Chicago, Ill.
authors.forename: Steven
authors.initials: S
authors.lastname: Greenberg
authors.affiliation: Division of Vascular Surgery, NorthShore University HealthSystem, Evanston, Ill; Division of Vascular Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Ill.
authors.forename: Joseph
authors.initials: J
authors.lastname: Caprini
authors.affiliation: Department of Internal Medicine, Hospital de Mollet, Barcelona, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Muñoz
authors.affiliation: Department of Internal Medicine, Hospital Sierrallana, Cantabria, Spain.
authors.forename: Reina
authors.initials: R
authors.lastname: Valle
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal Bosch
mesh_terms: D057785:Catheters / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D011655:Pulmonary Embolism / Q000209:etiology*; D012008:Recurrence; D012042:Registries; D013927:Thrombosis / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology*