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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

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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.

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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

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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.

Author information

Authors and Affiliations

  1. Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Mohammad Refaei

  2. Department of Nursing, University of Alberta, Edmonton, Alberta, Canada

    Bruna Fernandes

  3. Division of Hematology, Department of Medicine, University of Alberta, 4-112 Clinical Sciences Building, University of Alberta Hospital, 11350-83 Ave, Edmonton, Alberta, T6G2G3, Canada

    Joseph Brandwein & Cynthia Wu

  4. Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Marilyn Dawn Goodyear

  5. Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada

    Arun Pokhrel

Authors
  1. Mohammad Refaei
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  2. Bruna Fernandes
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  4. Marilyn Dawn Goodyear
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  5. Arun Pokhrel
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  6. Cynthia Wu
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Corresponding author

Correspondence to Cynthia Wu.

Ethics declarations

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.

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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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Refaei, M., Fernandes, B., Brandwein, J. et al. 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. Ann Hematol 95, 2057–2064 (2016). https://doi.org/10.1007/s00277-016-2798-4

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