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Cancer Med. 2017 Nov;6(11):2732-2744. doi: 10.1002/cam4.1201. Epub 2017 Oct 4.

Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study.

Author information

1
Department of Medical Oncology, Sainte Catherine Institute, Avignon, France.
2
Breast Cancer Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
3
University Paris Diderot, Paris, France.
4
Biostatistic Department and Medical Informatics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
5
Medical Oncology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
6
Francilian Breast Intergroup, APREC, IUC-UPMC Sorbonne University, Paris, France.
7
Department of Vascular Medicine, Sainte Musse Hospital, Toulon, France.
8
Department of Gynecology and Surgery, CHRU, Brest, France.
9
Department of Biology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
10
Department of Anesthesiology and Reanimation, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
11
Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
12
Sorbonne Universités, UPMC Université Paris 06, UMR_S 1166, Paris, France.
13
Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.
14
Internal Medicine Unit: Autoimmune and Vascular Diseases, UF 04, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France.

Abstract

Previous epidemiologic studies investigating central venous catheter (CVC)-related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)-CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double-blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow-up. Symptomatic DUS-CRT were treated by anticoagulants. D-Dimers, thrombin generation, and platelet-derived microparticles were measured before and 2 days after CVC placement. In DUS-CRT patients, a nested case-control study analyzed the role of thrombophilia. Among 524 patients, the DUS-CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient-months). Ten/14 symptomatic DUS-CRT were detected on double-blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS-CRT. Age >50 years (OR, 1.80; 95% CI, 1.01-3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46-4.76) and comorbidities (OR, 2.05; 95% CI, 1.18-3.56) were associated with DUS-CRT. No biomarkers was found to predict DUS-CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46-4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32-4.96) remained the only significant DUS-CRT risk factors. Thrombophilia did not account for DUS-CRT. Only clinical parameters identified high risk DUS-CRT patients who may be considered for thromboprophylaxis.

KEYWORDS:

Breast cancer; central venous catheter; chemotherapy; risk factors; venous thromboembolism

PMID:
28980454
PMCID:
PMC5673948
DOI:
10.1002/cam4.1201
[Indexed for MEDLINE]
Free PMC Article

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