Aims: Reliable and safe central venous access is needed to facilitate chemotherapy for many cancer patients. However, central venous catheter associated thrombosis (CVCT) is a common complication that can cause significant morbidity and mortality. There is a paucity of primary research examining the nature of CVCT in Australian cancer populations or exploring its management. Better understanding of factors predisposing to CVCT may allow prophylactic interventions to be better targeted to high-risk populations and influence decisions regarding choice of venous access device.
Methods: This multi-centre retrospective cohort study investigated factors associated with CVCT in cancer patients undergoing chemotherapy, using unadjusted and multivariate analyses. The management of CVCT was also described.
Results: 402 cases of central line insertion were included, corresponding to 317 patients and 166,972 catheter days. Catheter associated deep venous thrombosis occurred in 20 patients (5.0%) and isolated superficial venous thrombosis occurred in four patients (1.0%). Factors associated with CVCT in univariate analysis included the proceduralist (p=0.04), catheter type (p=0.009), catheter site (p=0.02), BMI (p=0.03) and antithrombotic use (p=0.04). On multivariate analysis, peripherally inserted central catheters (hazard ratio [HR] 4.39, 95% confidence interval [CI] 1.80-10.70, p<0.001) and body mass index ≥25.0 kg/m2 (HR 3.32, 95% CI 1.23-8.94, p=0.02) remained significantly associated with thrombosis. CVCT was managed with line removal (19/24 cases) and anticoagulation, including direct oral anticoagulants (DOACs) in five patients.
Conclusions: This is the largest Australian study investigating CVCT in cancer patients to the authors' knowledge. Peripherally inserted central catheters and increased body mass index were associated with an independently increased risk of CVCT and this was often managed with catheter removal. Further research into the use of DOACs for CVCT prophylaxis or management would be of benefit and is particularly topical in light of recent developments in DOAC use in malignancy.