OC12 | RISK OF VENOUS THROMBOEMBOLISM AFTER REMOVAL OF AN UPPER EXTREMITY CENTRAL CATHETER ASSOCIATED WITH A DEEP VEIN THROMBOSIS IN CANCER PATIENTS
M. Sartori, A. Trentini, S. Cavara, E. Favaretto, M. Soldati, B. Cosmi | Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
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Background. Removal of a central venous catheter (CVC) is often considered when catheter-associated upper extremity deep vein thrombosis (DVT) is diagnosed, whereas guidelines suggest not removing the catheter as long as it is in use, functional, well-positioned with a proximal extremity at the right atrial superior vena cava junction, and non-infected. However, it is unknown what the best strategy is in cancer patients with CRT.
Aim. The goal is to evaluate the effectiveness of removal versus retention of the thrombosed catheter.
Methods. This was a prospective, single-center study. We enrolled 233 participants (age: 56.8±16.6y, female: 58.4%) with cancer (metastatic cancer: 39.1%) and CRT. The follow-up was 12 months and the primary endpoint was the composite measure of recurrent CRT and pulmonary embolism (PE).
Results. All the patients were treated with enoxaparin for 3 months, of whom 22 (9.4%) underwent CVC removal ≤7 days from the diagnosis, 44 (18.9%) underwent CVC removal between 8 and 30 days, and 116 (49.8%) underwent CVC removal >30 days. A new CVC was inserted in 56 patients (24%). During the follow-up, there were 1 PE (2.4/100 patient-years, 95% CI: 0.4-12.6) and 9 CRT (22.0/100 patient-years, 95% CI: 12.0-36.7) recurrences in patients that retained the CVC, no PE, and 2 upper extremity thrombosis recurrences (1.6/100 patient-years, 95% CI: 0.5-5.8) in patients that underwent CVC removal, and 2 PEs (4.9/100 patient-years, 95% CI: 1.4-16.1) and 17 CRT recurrences (41.4/100 patient-years, 95% CI: 27.8-56.6) in patients that underwent catheter removal and insertion of a new CVC. The insertion of a new CVC sharply increased the risk of VTE recurrences (HR 6.11, 95% CI: 2.96–12.6, p < 0.001).
Conclusions. The maintenance of the thrombosed catheter is justified and associated with less VTE risk than removing the thrombosed catheter and inserting a new one.
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