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- Title
Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study.
- Authors
Debourdeau, Philippe; Espié, Marc; Chevret, Sylvie; Gligorov, Joseph; Elias, Antoine; Dupré, Pierre François; Desseaux, Kristell; Kalidi, Issa; Villiers, Stephane; Giachetti, Sylvie; Frere, Corinne; Farge, Dominique
- 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.
- Subjects
BREAST cancer treatment; ANTICOAGULANTS; CENTRAL venous catheterization; THROMBOEMBOLISM; EPIDEMIOLOGY; HEALTH outcome assessment
- Publication
Cancer Medicine, 2017, Vol 6, Issue 11, p2732
- ISSN
2045-7634
- Publication type
Article
- DOI
10.1002/cam4.1201