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Annals of Hematology

, Volume 95, Issue 12, pp 2057–2064 | Cite as

Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters

  • Mohammad Refaei
  • Bruna Fernandes
  • Joseph Brandwein
  • Marilyn Dawn Goodyear
  • Arun Pokhrel
  • Cynthia WuEmail author
Original Article

Abstract

Central venous catheters are a leading cause of upper-extremity deep vein thrombosis. Concomitant severe thrombocytopenia makes anticoagulation for catheter-related thrombosis (CRT) in patients with acute leukemia (AL) a challenge. Incidence of CRT has been reported to be increased in those with peripherally inserted central catheters (PICC) vs. those with centrally inserted ones (CICC). Our objective is to compare the incidence rate of CRT in leukemia inpatients who received either a PICC vs. CICC. We retrospectively reviewed adult inpatients admitted to hematology wards with a new diagnosis of AL and who received either a PICC or a CICC. Baseline patient and catheter characteristics were recorded. Our primary outcome was the incidence rate of CRT in each group. The secondary outcomes included rates of infectious and mechanical complications. Six hundred sixty-three patients received at least one PICC (338) or CICC (325) insertion. A total of 1331 insertions were recorded, with 82 (11.7 %) and 41 (6.5 %) CRT in the PICC and CICC groups, respectively. The incidence rates were 1.89 and 0.52 per 1000 catheter day in the PICC and CICC groups, respectively. A PICC, when compared to CICC, was a significant risk factor for CRT (sHR 2.5, p < 0.0001). The prevalence and incidence rates of CRT in our AL patients were higher than predicted for a general cancer patient population. These rates were higher in the PICC group compared to the CICC group. We recommend careful consideration of thrombotic and bleeding risks of AL inpatients when choosing a central venous catheter.

Keywords

Catheter-related thrombosis Central venous catheter Leukemia Upper extremity deep vein thrombosis Venous thromboembolism 

Abbreviations

AL

Acute leukemia

CICC

Centrally inserted central venous catheter

CRT

Catheter-related thrombosis

CVC

Central venous catheter

DVT

Deep vein thrombosis

HRT

Hormonal replacement therapy

HSCT

Hematopoietic stem cell transplant

OCP

Oral contraceptive pills

PE

Pulmonary embolism

PICC

Peripherally inserted central venous catheter

sHR

Subhazard ratio

VTE

Venous thromboembolism

Notes

Authors’ contribution

M. Refaei and C. Wu developed the research protocol. M. Refaei and B. Fernandes performed primary data collection. M. Refaei prepared the manuscript. A. Pokhrel performed statistical analysis. Manuscript was reviewed and approved for publication by J. Brandwein, M. D. Goodyear, and C. Wu.

Compliance with ethical standards

Ethics approvals from both cities were obtained (Edmonton Pro00051738; Calgary REB14-1916), in keeping with the Canadian Tri-Council Policy statement on ethical conduct for research.

Conflict of interest

C. Wu is a member on advisory board with honoraria from Leo Pharma and Pfizer. M.D. Goodyear has received research grants from Bayer and Pfizer. The rest of the authors declare no conflict of interest.

Supplementary material

277_2016_2798_MOESM1_ESM.docx (84 kb)
Supplemental Table S1-Table S3 Incidence of Catheter-related Thrombosis in Acute Leukemia patients: a comparative, retrospective study of the safety of Peripherally-Inserted vs. Centrally-Inserted Central Venous Catheters. (DOCX 84 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Division of Internal Medicine, Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Department of NursingUniversity of AlbertaEdmontonCanada
  3. 3.Division of Hematology, Department of MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Division of Hematology, Department of MedicineUniversity of CalgaryCalgaryCanada
  5. 5.Women and Children’s Health Research InstituteUniversity of AlbertaEdmontonCanada

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