Etiology and management of upper-extremity catheter-related thrombosis in cancer patients

Anita Rajasekhar, Michael B Streiff

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Central venous access devices are a critical instrument in the treatment and supportive care delivery for oncology patients. Catheter-related thrombosis (CRT) is a common complication of central venous access devices in oncology patients. Risk factors for CRT include patient-, device-, and treatment-related risk factors. Treatment of CRT is indicated to reduce symptoms, prevent catheter malfunction, prevent recurrent DVT or thromboembolic pulmonary embolism, and minimize the risk of post-thrombotic syndrome. Minimal prospective data exist on the prevention and treatment of catheter-related thromboses in cancer patients. As such recommendations largely are derived from data in the lower-extremity DVT and PE studies in cancer and non-cancer patients. Based on the available literature, primary pharmacologic prophylaxis against CRT is not recommended in cancer patients. Treatment options for CRT include catheter removal, anticoagulation, catheter-directed thrombolysis, or surgical thrombectomy. Current evidence-based guidelines recommend LMWH as the anticoagulant of choice. However, recent data showing efficacy and safety of DOACs in cancer-related VTE may be extrapolated to treatment of CRT in cancer patients. In patients with CRT, catheter removal should be pursued if continued vascular access is no longer needed, the catheter is dysfunctional, a catheter-associated infection is present, or if CRT symptoms do not resolve with anticoagulation alone. Catheter-directed thrombolysis is reserved for rare severe cases of CRT. Herein we discuss the pathophysiology, clinical presentation, diagnosis, and general management of CRT in cancer patients.

Original languageEnglish (US)
Title of host publicationCancer Treatment and Research
PublisherSpringer International Publishing
Pages117-137
Number of pages21
DOIs
StatePublished - Jan 1 2019

Publication series

NameCancer Treatment and Research
Volume179
ISSN (Print)0927-3042

Keywords

  • Cancer
  • Catheter-related thrombosis
  • Thrombosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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  • Cite this

    Rajasekhar, A., & Streiff, M. B. (2019). Etiology and management of upper-extremity catheter-related thrombosis in cancer patients. In Cancer Treatment and Research (pp. 117-137). (Cancer Treatment and Research; Vol. 179). Springer International Publishing. https://doi.org/10.1007/978-3-030-20315-3_8