CENTRAL VENOUS THROMBOSIS - AN EARLY AND FREQUENT COMPLICATION IN CANCER-PATIENTS BEARING LONG-TERM SILASTIC CATHETER - A PROSPECTIVE-STUDY

Studies on catheter-related central venous thrombosis (CRCVT) have bee n focused mainly on clinically evident CRCVT due to occlusive thrombi, underestimating therefore the actual thrombosis prevalence. This pros pective study was aimed at evaluating prevalence, timing and evolution of thrombosis, and identifying involved veins and risk factors in can cer patients (pts) undergoing percutaneous subclavian central venous c atheterization (CVC) for chemotherapy, parenteral nutrition or both. W e enrolled 127 consecutive pts requiring partially or totally implante d central venous silastic catheters. The study protocol included perip heral phlebography (P) at day 8, 30 and every two months following CVC and/or when clinically indicated, along with peripheral and pullout P on catheter withdrawal. A quantitative scale was developed to evaluat e thrombus grading in subclavian, innominate and cava veins. Age, sex, coagulation profile, tumor histotype, metastases, therapy, catheter t ype, and catheter insertion side were also investigated. Only pts who underwent at least two P were evaluated, and chi(2) test was adopted f or statistical analysis. Altogether, 95 pts were evaluable. CRCVT was observed in 63/95 (66%) pts. At day 8, 30 and 105 (representing the me dian days in which first, second and last P were performed) CRCVT was evidenced in 64%, 65% and 66% of the pts, respectively. Thrombus gradi ng did not differ among first, second and last P. CRCVT was symptomati c in 4/63 (6%) pts. Thrombosis prevalence was higher in subclavian (97 %) with respect to innominate (60%) or cava (13%) veins (p<0.001). Thr ombosis was higher in left subclavian catheters (14/16; 87.5%) than in right ones (49/79; 62%), p<0.01. No associations were established bet ween CRCVT and other investigated parameters. Our data show a very hig h actual frequency of CRCVT in cancer pts, and emphasize that first da ys following CVC are at the highest risk for CRCVT development. Based on our results, a study on short-term antithrombotic prophylaxis in ca ncer pts requiring CVC is warranted. Finally, our data indicate that l eft subclavian vein catheterization represents a risk factor for CRCVT . (C) 1997 Elsevier Science Ltd.