Risk Factors for Upper Extremity Venous Thrombosis Associated with Peripherally Inserted Central Venous Catheters

2012 ◽  
Vol 13 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Thomas Marnejon ◽  
Debra Angelo ◽  
Ahmed Abu Abdou ◽  
David Gemmel
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Upper Extremity ◽  
Central Venous Catheters ◽  
Central Venous

scholarly journals Upper Extremity Venous Thrombosis in Patients With Cancer With Peripherally Inserted Central Venous Catheters: A Retrospective Analysis of Risk Factors

2013 ◽  
Vol 9 (1) ◽  
pp. e8-e12 ◽  
Author(s):  
Daniel H. Ahn ◽  
Henrik Bo Illum ◽  
David H. Wang ◽  
Anant Sharma ◽  
Jonathan E. Dowell
Keyword(s):  
Risk Factors ◽  
Protective Effect ◽  
Venous Thrombosis ◽  
Retrospective Analysis ◽  
Upper Extremity ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Patients With Cancer ◽  
Specific Factors

Specific factors significantly increase the risk of upper extremity venous thrombosis in patients with cancer with PICCs, whereas use of anti-platelet agents seems to have a protective effect against it.

Upper Extremity Deep Vein Thrombosis in Medical Inpatients and Association with Central Venous Catheters: Results From the Medical Inpatients and Thrombosis (MITH) Study.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2251-2251
Author(s):  
John P. Winters ◽  
Mary Cushman ◽  
Peter W Callas ◽  
Allen B Repp ◽  
Neil A Zakai
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Medical Inpatients ◽  
Hospital Acquired ◽  
Deep Vein

Abstract Abstract 2251 Introduction: Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized complication in medical inpatients, contributing to morbidity and increased cost of hospitalizations. Despite the rising use of central venous catheters (CVCS), there is little data available on incidence and risk factors for UEDVT in medical inpatients. Methods: All cases of hospital-acquired VTE (Venous Thromboembolism) were identified using ICD-9 codes and confirmed by medical record review at a 500-bed teaching hospital in the United States between January 2002 and June 2009. Hospital-acquired VTE was defined as imaging confirmed deep venous thrombosis (DVT) of the limbs or pulmonary emboli (PE) occurring during the hospitalization and not present on admission. Controls without VTE ICD-9 codes were matched 2:1 to cases by admission year and service. A standard form was used to collect information on both cases and controls including use of CVCs. CVC use in the controls was used to estimate CVC use in medical inpatients based on the sampling frequency. Weighted logistic regression was used to calculate odds ratios (OR) for VTE for CVCs after adjusting for VTE risk factors from a previously developed VTE risk assessment model. Results: 299 cases of VTE complicated 64,034 admissions (4.6 per 1000 admissions). A total of 51% (91/180) of DVTs were UEDVT, for an overall incidence of 1.4 (95% CI 0.8–1.4) per 1000 admissions. There were 247 (95% CI 203, 292) CVCs placed per 1000 admissions. PICC lines were placed in 87 (95% CI 62, 113) per 1000 admission, non-PICC upper extremity CVCs in 127 (95% CI 99, 156) per 1000 admissions and lower extremity CVCs in 17 (95% CI 9, 25) per 1000 admissions. VTE incidence was 10.0 (95% CI 7.4, 12.5) per 1000 admissions in patients with a CVCs vs. 3.0 (95% CI 2.4, 3.6) per 1000 in patients without a CVC. The incidence of UEDVT was 4.9 (95% CI 3.3 – 6.2) per 1000 admissions in patients with CVCs versus 0.3 (95% CI 0.2 – 0.5) per 1000 admissions in patients without CVCs. The adjusted ORs for VTE are presented in the table. Risk of upper extremity DVTs was strongly associated with use of CVCs (OR 14.0; CI 5.9–33.2), with the highest risk associated with PICCs (13.0 (6.1–27.6), followed by lower extremity CVCs, and non-PICC upper extremity CVCs. Placement of lower extremity CVCs was associated with the highest odds of PE and lower extremity DVT. Most (72%) patients with lower extremity CVCs also had an upper extremity line placed prior to their VTE. The odds of PE were increased in non-PICC upper extremity CVC and lower extremity CVCs but not PICCs (Table). CVCs placed prior to the hospitalization were not associated with an increased risk of VTE. Conclusion: For the first time we demonstrate the impact CVCs have on hospital-acquired VTE in medical inpatients. Quality organizations and clinical trials of VTE prevention have not addressed UEDVTs, however they are frequent in medical inpatients and contribute to morbidity and medical costs. Increased awareness of UEDVTs associated with CVCs and inclusion of these events in clinical trials of VTE prophylaxis are needed to develop appropriate preventive strategies. Disclosures: Cushman: Beckman: Honoraria.

scholarly journals Thromboembolic Complications in Patients with Sickle Cell Disease

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4913-4913
Author(s):  
Salam Alkindi ◽  
Anwaar Al-Ghadani ◽  
Samah Al-zeheimi ◽  
Anil Pathare
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
Venous Thrombosis ◽  
Sickle Cell ◽  
Significant Risk ◽  
Central Venous Catheters ◽  
Morbidity And Mortality ◽  
Thromboembolic Complications ◽  
Cell Disease ◽  
Central Venous

Abstract Background and Purpose: Venous thromboembolism (VTE) is common in patients with sickle cell disease (SCD). Traditional risk factors such as central venous catheters, frequent hospitalization, orthopedic surgeries for avascular necrosis, and pregnancy often leads to an increased incidence of VTE in the SCD. In addition, SCD itself appears to be a hypercoagulable state with many SCD-specific factors such as genotype, splenectomy and thrombophilia modifying the risk of VTE. This study aims to assess the clinical and pathological characteristics of VTE amongst a cohort of patients with SCD at the Sultan Qaboos University Hospital and determine its relation to morbidity and mortality. Methodology: In this retrospective case control study, medical details of all patients with SCD who developed thromboembolic complications over the past decade were retrieved from the hospital information system. SCD patients matched for age and gender (2:1 ratio) who did not have thromboembolic complications but had a thrombophilia screen performed served as controls. The study was approved by the local Medical Research and Ethics Committee. Results & Discussion: A total of 53 SCD patients were enrolled [34 cases, 19 controls] in this study. Amongst the 34 cases (mean age-30 yrs.), 18 had pulmonary embolism, eight had deep venous thrombosis, whereas, three each had cerebral venous thrombosis and portal venous thrombosis and one each had cerebral arterial thrombosis and VTE. A higher incidence of autosplenectomy(69.7% v/s 52.6%) and central venous catheters(42.4% v/s 5.3%) were significantly associated with thrombosis (p<0.05, Chi Square test). High LDH levels, WBC and Platelet counts were significant risk factors(p<0.05) for VTE. 21 patients [63.6%] amongst the cases developed acute chest syndrome, where 3[9%] had cerebrovascular accident. Mortality was seen in seven cases [21%]. Conclusions: The study shows that thromboembolic complications in SCD has a high impact on the morbidity and mortality. It confirms PE as the leading cause for VTE in SCD with asplenia, central venous catheter, high LDH, WBC and Platelet counts being significant risk factors. Disclosures No relevant conflicts of interest to declare.

Catheter-Associated Thrombosis in Patients With Malignancy

2009 ◽  
Vol 27 (29) ◽  
pp. 4858-4864 ◽  
Author(s):  
Sudeep P. Shivakumar ◽  
David R. Anderson ◽  
Stephen Couban
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Indwelling Catheters ◽  
Patients With Cancer

Central venous catheters are widely used in the care of patients with cancer. Indwelling catheters are associated with upper extremity deep venous thrombosis in some patients, and recognition of this entity is an important aspect of treating patients with malignancies. This article will review the incidence, pathogenesis, clinical presentation, diagnosis, treatment, and prophylaxis of catheter-assocated thrombosis in patients with malignancy. The care of pediatric patients with malignancy and catheter-associated thrombosis will also be addressed.

Cerebral Venous Thrombosis in Adolescents and Young Adults with Classical Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4784-4784
Author(s):  
Poornima Kumar ◽  
Rebekah Ahmed ◽  
Renu Riat ◽  
Kirit M Ardeshna ◽  
Stephen Daw
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Venous Thrombosis ◽  
Hodgkin Lymphoma ◽  
Cerebral Venous Thrombosis ◽  
Central Venous Catheters ◽  
Adolescents And Young Adults ◽  
Classical Hodgkin Lymphoma ◽  
Central Venous ◽  
Life Threatening

Abstract Abstract 4784 Background Patients with classical Hodgkin Lymphoma (cHL) have a relatively high risk of venous thrombo-embolism (VTE); reported incidence 4.6–7% in adults and up to 11.5% in children and adolescents. Most VTE episodes are peripheral or related to central venous catheters, with very limited data on central or life-threatening thromboses in adolescents. There is only 1 reported case series on cerebral venous thrombosis (CVT) in adolescents. We report 4 cases of CVT from our centre, all treated with chemo-radiotherapy. Chemotherapy comprised OEPA (vincristine, prednisolone, doxorubicin, etoposide) and COPP/COPDAC (cyclophosphamide, vincristine, prednisolone, procarbazine/dacarbazine respectively). Results All patients received involved field radiotherapy (IFRT) 19.8 – 30Gy on completing chemotherapy. All were female, aged 12–23. All received norethisterone contraception. All had indwelling central venous catheters (PICC). Patient 4 alone had a raised body mass index. All were exposed to steroids; Patient 4 completed steroid therapy several weeks before developing CVT symptoms. Patients 2 and 4 received treatment dose low molecular weight heparin (LMWH) for 6 weeks after diagnosis of PICC-associated thrombosis, and were not on anticoagulation or thromboprophylaxis when CVT was diagnosed. Regarding other risk factors, 3/4 had no documented prothrombotic tendency. Patient 4 was found to have a moderately positive IgM anti beta 2 glycoprotein antibody present 12 weeks apart, consistent with antiphospholipid syndrome. All patients were therapeutically anticoagulated for 6 months to 1 year. LMWH of choice at our centre was dalteparin. Patient 1 was switched to warfarin upon completion of chemo-radiotherapy, and Patient 4 was commenced on warfarin with dalteparin cover at diagnosis of CVT as she had completed treatment. Patients 1 and 2 had raised intracranial pressure on lumbar puncture, and required therapeutic lumbar punctures and acetazolamide. Patients 2 and 3 both required anticonvulsant therapy for 1 year. Patient 2 was initially treated with phenytoin, and switched to carbamazepine. Patient 3 was also initially managed with phenytoin, and switched to levetiracetam. Neither patient had any subsequent seizures. All 4 patients have recovered completely from CVT with no residual neurological deficits or further thromboses. Conclusion CVT is a rare and potentially life threatening complication in adolescents and young adults with cHL with paucity of data. The risk factors are unclear however all patients in our series were female, received steroids and were on norethisterone. Only 1 patient had a prothrombotic tendency detected on thrombophila screening. CVT is treatable, and complete resolution of signs and symptoms can be expected. More studies are required to elucidate risk factors which may help develop thromboprophylaxis guidance in this group of patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters

2019 ◽  
Vol 123 (3) ◽  
pp. 316-324 ◽  
Author(s):  
Åsa Östlund ◽  
Urban Fläring ◽  
Åke Norberg ◽  
Ann Dahlberg ◽  
Jonas Berner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Central Venous Catheters ◽  
Central Venous
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