Written in Blood
Risk of Thrombosis in Patients With Cancer and Implanted Ports
Although patients with solid-tumor
cancers and implanted ports have a
high risk for venous thromboembolism
(VTE), guidelines advise against
routine thromboprophylaxis, given
the wide variation in thrombotic
risks in this setting. In results from a
prospective cohort study published
in Blood, researchers determined
risk factors associated with
thromboembolic events in this
patient population that could
help identify patients who would
benefit from thromboprophylaxis.
Specifically, the use of the cephalic
vein for catheter insertion was a
substantial risk factor for catheter-
related thrombosis, but not for non–
catheter-related thrombosis.
“That risk factors for catheter-
related thrombosis differ from those
for VTE unrelated to the catheter was
an unexpected finding and may have
clinical implications,” the authors, led
by Hervé Decousus, MD, of the Cen-
tre d’Investigation Clinique, in Saint-
Etienne, France, wrote. Data from this
real-world study may help risk-stratify
patients and guide decisions about
catheter insertion site and antiplatelet
or anticoagulant therapy.
To identify risk factors for
catheter-related thrombosis and non–
catheter-related VTE in patients with
an implanted port, the ONCOCIP
(ONCOlogie et Chambres ImPlant-
ables) study included 3,032 adult
patients (median age = 63 years; range
not reported) from 29 French medi-
cal centers. The most common cancer
sites were breast (33.7%), lung (18.5%),
and colon (15.6%), and 43.2 percent of
patients had metastatic cancer. Nearly
all patients (97.1%) received chemo-
therapy.
Follow-up consisted of in-person,
face-to-face visits every month for
up to six months, then every three
months for up to 12 months (or until
death or port removal). Participants
were directed to report to the study
center immediately if any signs or
symptoms occurred, including any
thromboembolic event, infection, or
local port-related complication.
At 12-month follow-up, 656 pa-
tients (21.6%) had died, and 48 (1.6%)
were lost to follow-up. Another 479
patients (15.8%) discontinued the study
prematurely due to definitive port
removal.
Overall, thrombosis occurred in
397 patients (13.8%), including:
• catheter-related thrombosis: 111
patients (3.8%)
• non–catheter-related VTE: 276
patients (9.6%)
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ASH Clinical News
Catheter-related thrombosis included 106
patients (3.8%) who developed an upper-
extremity deep vein thrombosis and five
patients (0.2%) who developed a pulmo-
nary embolism associated with upper-
extremity deep vein thrombosis.
The median time to any symptomatic
catheter-related thrombosis was 45 days
(range = 23-99 days). In addition, of the
397 patients who experienced a throm-
boembolic event, 329 (82.9%) received
anticoagulation at therapeutic dose.
In multivariate analyses, use of the
cephalic vein for catheter insertion was
the only risk factor significantly and
independently associated with 12-month
catheter-related thrombosis (hazard ratio
[HR] = 2.51; 95% CI 1.68-3.75; p<0.0001).
Conversely, ongoing use of antiplatelet
therapy at baseline had a protective effect
and was independently associated with a
reduced risk of catheter-related throm-
bosis at 12 months (HR=0.44; 95% CI
0.21-0.90; p=0.024).
However, neither of these risk factors
were associated with rates of non–catheter-
related VTE at 12 months. The researchers
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