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Risk for cancer-associated thrombosis high with implanted ports
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Venous thromboembolism incidence appeared high among patients with solid tumors who had implanted ports, according to study results.
Risk factors for catheter-related VTE differed from the factors that contribute to VTE not caused by catheters, results showed.
“This large prospective cohort study showed a high rate of thrombotic events in patients with a solid tumor and an implanted port in the real-life practice setting, and identified independent risk factors that may be useful for risk stratification,” Hervé Decousus, MD, from the vascular medicine service at Hôpital Nord in France, and colleagues wrote.
Long-term central venous catheters have been increasingly used among various populations of patients with cancer who require chemotherapy and IV supportive care treatments, despite a risk for thrombotic events.
Few studies have looked at risk factors for catheter-related thrombosis, although accurate risk stratifications are needed and considered a priority.
Decousus and colleagues evaluated 3,032 consecutive ambulatory patients (median age, 63 years; 58% women) with solid tumors who had undergone port implantation. One-third of patients (33.7%) had breast cancer, whereas 18.5% had lung cancer, and 15.6% had colon or rectum cancer. Less than half (43.2%) of patients had metastatic disease, and nearly all (97.1%) had received chemotherapy.
Patients underwent face-to-face visits every month for 6 months, then every 3 months thereafter, with total follow-up of up to 1 year.
Researchers instructed patients to report any symptoms or signs of thromboembolic events, infections or local port-related complications.
The study ended for each patient when the port was definitively removed, at the planned 1-year visit or upon death.
Classification of risk factors for catheter-related thrombosis, as well as VTE unrelated to the catheter, in a real-life practice setting served as the study’s primary objective.
Researchers defined catheter-related thrombosis as ipsilateral symptomatic upper-limb deep vein thrombosis with or without pulmonary embolism. They considered VTE unrelated to catheters to include any symptomatic superficial or deep vein thrombosis or PE and incidental PE.
By 1-year follow-up, 1.6% of patients had been lost to follow-up and 24.6% died.
Results showed 397 (13.8%) patients developed thromboembolic complications of any kind by 1 year. Median time to any thromboembolic event was 67 days (interquartile range [IQR], 30-137).
Researchers determined 378 (13.1%) of patients developed VTE; 276 of the 378 VTE cases were not catheter related.
Results showed 142 patients (5%) developed PE; of these cases, 37 were fatal and 58 were incidental.
Symptomatic catheter-related thrombosis occurred among 3.8% (95% CI, 3.2-4.5) of patients.
Median time to any symptomatic catheter-related thrombosis was 45 days (IQR, 23-99).
Multivariate analysis showed use of a cephalic vein for catheter insertion was the only predictor of catheter-related thrombosis (HR = 2.51; 95% CI, 1.68-3.75).
The analysis also showed ongoing antiplatelet therapy at baseline decreased 1-year risk for catheter-related thrombosis (HR = 0.44; 95% CI, 0.21-0.9).
Risk factors for noncatheter-related VTE included age 60 years or older, previous VTE, cancer site, and low hemoglobin level or increased leukocyte count before chemotherapy.
“Importantly, risk factors for catheter-related thrombosis differed from those for VTE unrelated to the catheter, suggesting that measures to prevent each type of event may also differ,” the researchers wrote. – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.
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