CO06 | Recurrences of catheter associated upper extremity deep vein thrombosis in cancer: a two year prospective study with enoxaparin

M. Sartori, A. Trentini, S. Cavara, L. Borgese, M. Soldati, B. Cosmi | Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy

Background: The upper extremity deep vein thrombosis (UEDVT) in association with use of central venous catheters is a frequent finding in patients with cancer. Current guidelines suggest three month anticoagulation for the treatment of catheter-related UEDVT (CRT) in cancer patients, but few data are available on the appropriate anticoagulant strategy beyond three months.

Aim: To ascertain the long term venous thromboembolism (VTE) recurrences for CRT.

Study design: A single centre prospective management study in 233 cancer patients with CRT. All patients received enoxaparin 1 mg/kg subcutaneously twice a day for 4 weeks followed by 1.5 mg/kg subcutaneously once a day for a maximum of 5 weeks. The follow-up was 24 months and the end-point was the composite measure of recurrent VTE defined as: recurrence or extension of CRT, lower leg DVT, cerebral vein thrombosis, splancnic vein thrombosis and pulmonary embolism (PE).

Results: The study population had a mean age of 57.5±16.3 (female 55.5%); metastatic cancer was present in 165 (47.7%) patients. During the 2-year follow-up, there were 74 deaths (31.8%), whereas complete cancer remission was observed in 92 patients (39.4%). Ongoing enoxaparin treatment, the primary efficacy outcome occurred in 7 patients (3.0%), whereas major bleedings were 2.1%. After anticoagulant suspension, there were three PEs (1.3%), one cerebral sinus thrombosis (0.4%) and 25 recurrent CRT (10.7%). Patients that received enoxaparin treatment for 3 months has the same risk of reaching the end-point than those that received enoxaparin for more than 3 months (RR 1.21, CI95%: 0.26-5.56, p=0.806) The primary efficacy outcome occurred in (20.1%) patients with active cancer, whereas no patients in complete cancer remission reached the primary end-point. The use of thromboprophylaxis reduced the risk of VTE (RR 0.22, CI95%: 0.08-0.60, p=0.02).

Conclusions: The risk of recurrence of CRT is mainly related to cancer status. In case of active cancer, the risk of recurrent VTE is not low and thromboprophylaxis may reduce it.