International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer

P. Debourdeau, D. Farge, M. Beckers, C. Baglin, R. M. Bauersachs, B. Brenner, D. Brilhante, A. Falanga, G. T. Gerotzafias, N. Haim, A. K. Kakkar, A. A. Khorana, R. Lecumberri, M. Mandala, M. Marty, M. Monreal, S. A. Mousa, S. Noble, I. Pabinger, P. PrandoniM. H. Prins, M. H. Qari, Michael B Streiff, K. Syrigos, H. R. Büller, H. Bounameaux

Research output: Contribution to journalArticle

Abstract

Background:Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives:To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. Methods:An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. Results:For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman® catheter vs. closed-ended catheter with a valve like the Groshong® catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. Conclusion:Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.

Original languageEnglish (US)
Pages (from-to)71-80
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Volume11
Issue number1
DOIs
StatePublished - Jan 2013

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Central Venous Catheters
Practice Guidelines
Thrombosis
Anticoagulants
Vitamin K
Low Molecular Weight Heparin
Neoplasms
Catheters
Superior Vena Cava
Fibrinolytic Agents
Retrospective Studies
Therapeutics
Heart Atria
Safety
Meta-Analysis
Upper Extremity Deep Vein Thrombosis
Prospective Studies
Health Priorities
Indwelling Catheters
Evidence-Based Medicine

Keywords

  • Anticoagulant
  • Cancer
  • Catheter
  • Clinical practice guidelines
  • GRADE system
  • Thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. / Debourdeau, P.; Farge, D.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, Michael B; Syrigos, K.; Büller, H. R.; Bounameaux, H.

In: Journal of Thrombosis and Haemostasis, Vol. 11, No. 1, 01.2013, p. 71-80.

Research output: Contribution to journalArticle

Debourdeau, P, Farge, D, Beckers, M, Baglin, C, Bauersachs, RM, Brenner, B, Brilhante, D, Falanga, A, Gerotzafias, GT, Haim, N, Kakkar, AK, Khorana, AA, Lecumberri, R, Mandala, M, Marty, M, Monreal, M, Mousa, SA, Noble, S, Pabinger, I, Prandoni, P, Prins, MH, Qari, MH, Streiff, MB, Syrigos, K, Büller, HR & Bounameaux, H 2013, 'International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer', Journal of Thrombosis and Haemostasis, vol. 11, no. 1, pp. 71-80. https://doi.org/10.1111/jth.12071
Debourdeau, P. ; Farge, D. ; Beckers, M. ; Baglin, C. ; Bauersachs, R. M. ; Brenner, B. ; Brilhante, D. ; Falanga, A. ; Gerotzafias, G. T. ; Haim, N. ; Kakkar, A. K. ; Khorana, A. A. ; Lecumberri, R. ; Mandala, M. ; Marty, M. ; Monreal, M. ; Mousa, S. A. ; Noble, S. ; Pabinger, I. ; Prandoni, P. ; Prins, M. H. ; Qari, M. H. ; Streiff, Michael B ; Syrigos, K. ; Büller, H. R. ; Bounameaux, H. / International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. In: Journal of Thrombosis and Haemostasis. 2013 ; Vol. 11, No. 1. pp. 71-80.
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TY - JOUR

T1 - International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer

AU - Debourdeau, P.

AU - Farge, D.

AU - Beckers, M.

AU - Baglin, C.

AU - Bauersachs, R. M.

AU - Brenner, B.

AU - Brilhante, D.

AU - Falanga, A.

AU - Gerotzafias, G. T.

AU - Haim, N.

AU - Kakkar, A. K.

AU - Khorana, A. A.

AU - Lecumberri, R.

AU - Mandala, M.

AU - Marty, M.

AU - Monreal, M.

AU - Mousa, S. A.

AU - Noble, S.

AU - Pabinger, I.

AU - Prandoni, P.

AU - Prins, M. H.

AU - Qari, M. H.

AU - Streiff, Michael B

AU - Syrigos, K.

AU - Büller, H. R.

AU - Bounameaux, H.

PY - 2013/1

Y1 - 2013/1

N2 - Background:Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives:To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. Methods:An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. Results:For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman® catheter vs. closed-ended catheter with a valve like the Groshong® catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. Conclusion:Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.

AB - Background:Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives:To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. Methods:An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. Results:For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman® catheter vs. closed-ended catheter with a valve like the Groshong® catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. Conclusion:Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.

KW - Anticoagulant

KW - Cancer

KW - Catheter

KW - Clinical practice guidelines

KW - GRADE system

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