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J Vasc Surg Venous Lymphat Disord. 2015 Jul;3(3):243-50.e1. doi: 10.1016/j.jvsv.2015.03.002. Epub 2015 Jun 15.

A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis.

Collaborators (145)

Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Alcalde M, Alibalic A, Arcelus JI, Auguet T, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Benítez JF, Blanco-Molina A, Casado I, Conget F, Del Molino F, Del Toro J, Díaz JA, Falgá C, Fernández-Capitán C, Font L, Gallego P, García-Bragado F, García A, Gómez-Durán M, Gómez V, González J, Grau E, Guijarro R, Gutiérrez J, Hernández L, Hernández-Huerta S, Jara-Palomares L, Jaras MJ, Jiménez D, Jiménez R, Jiménez S, Lecumberri R, Lobo JL, López-Jiménez L, López-Montes L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Macià M, Madridano O, Marchena PJ, Martín-Antorán JM, Martín-Martos F, Monreal M, Morales MV, Muñoz FJ, Nauffal D, Nieto JA, Núñez MJ, Otero R, Pagán B, Pedrajas JM, Pérez-Rus G, Peris ML, Pons I, Porras JA, Riera-Mestre A, Rivas A, Rodríguez-Dávila MA, Román P, Rosa V, Ruiz-Giménez N, Sabio P, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Soto MJ, Suriñach JM, Tiberio G, Tirado R, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vilella-Tomas V, Villalobos A, Villalta J, Malfante P, Verhamme P, Vanassche T, Wells P, Malý R, Hirmerova J, Bertoletti L, Bura-Riviere A, Moustafa F, Farge-Bancel D, Hij A, Mahe I, Merah A, Quere I, Schellong S, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Ciammaichella M, Valle F, Di Micco P, Ferrazzi P, Guida A, Maida R, Pace F, Pasca S, Piovella C, Prandoni P, Re R, Rota L, Tonello D, Tufano A, Visonà A, Zalunardo B, Malheiro J, Ribeiro JL, Sousa MS, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Caprini J, Serrano JC.

Author information

1
BloodCenter of Wisconsin, Department of Medicine/Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisc. Electronic address: Lisa.baumannkreuziger@bcw.edu.
2
Department of Nursing/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Chicago, Ill.
3
Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
4
Department of Anesthesia/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Chicago, Ill.
5
Division of Vascular Surgery, NorthShore University HealthSystem, Evanston, Ill; Division of Vascular Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Ill.
6
Department of Internal Medicine, Hospital de Mollet, Barcelona, Spain.
7
Department of Internal Medicine, Hospital Sierrallana, Cantabria, Spain.
8
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.

Abstract

BACKGROUND:

Few studies have investigated the treatment and the outcomes of patients with catheter-related thrombosis (CRT).

METHODS:

The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of consecutive patients with objectively confirmed venous thromboembolism (VTE). We analyzed the characteristics, treatment, and outcomes of patients with CRT.

RESULTS:

Of 558 patients with CRT, 45 (8%) presented with a pulmonary embolism (PE) concomitantly. More patients had central line-associated thrombosis compared with port systems, but catheter type did not influence the risk of presenting with a PE. Patients with only CRT were more often prescribed low-molecular-weight heparin for the duration of their anticoagulant treatment compared with patients presenting with concomitant PE. VTE recurrences and major bleeding events occurred frequently during treatment with anticoagulation (7 per 100 patient-years and 8.9 per 100 patient years, respectively). The rates of fatal PE recurrences (1.85 per 100 patient-years) and fatal bleeding (2.32 per 100 patient-years) were similar. Patients with an additional transient risk factor for VTE had the lowest risk for VTE recurrences (odds ratio [OR], 0.07; 90% confidence interval [CI], 0.01-0.45) compared with patients with CRT and no additional transient risk factors. PE at presentation increased the risk of recurrent thrombosis by 2.4 times. Renal insufficiency was also an independent predictor of recurrent thrombosis (OR, 3.93; 90% CI, 2.0-7.7). The odds of recurrent thrombosis was decreased by 77% in patients who received anticoagulation therapy for >90 days compared with patients with a shorter treatment (OR, 0.23; 90% CI, 0.1-0.56).

CONCLUSIONS:

Concomitant PE occurs less frequently in CRT than lower extremity deep venous thrombosis, but it is associated with a worse outcome. CRT occurs in high-risk patients, and duration of anticoagulation must be predicated on balancing these risks.

PMID:
26992301
DOI:
10.1016/j.jvsv.2015.03.002
[Indexed for MEDLINE]

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