Researchers characterized patterns of central venous catheter (CVC)-associated upper extremity deep vein thrombosis (UE-DVT) in a new study, with results reported in the journal Blood Advances.
“To our knowledge, this multi-institutional retrospective cohort study is the largest study to this date of CVC-associated UE-DVT in patients with hematologic malignancies,” the researchers explained in their report.
In this retrospective study, data were analyzed for patients with hematologic malignancies who had CVC-associated UE-DVT, treated at 8 centers included in the Venous thromboEmbolism Network US. The primary study outcome was objectively confirmed pulmonary embolism (PE) occurring in the first 7 days following a UE-DVT diagnosis in patients treated with anticoagulation, based on a comparison between patient groups who underwent early (≤48 hours) vs delayed (>48 hours) CVC removal.
The study evaluated 626 patients, and 480 of these patients received anticoagulation treatment. Early CVC removal occurred with 255 of the anticoagulated patients, while delayed CVC removal, or no CVC removal, occurred with 225 of the anticoagulated patients. From a total of 146 patients who were not treated with anticoagulation, 116 had CVC removal.
In patients who had early CVC removal, PE was reported within 7 days in 2 of the patients, for a rate of 0.78%, compared with 1 patient in the group of patients with delayed or no CVC removal (0.44%). This did not reflect a statistically significant difference in the rate of PE for these 2 groups (P >.9).
The rates of PE or any cause of death in the first 7 days of UE-DVT were 1.18% in the early CVC-removal group and 1.33% in the delayed/no CVC-removal group (P >.9). PEs were not reported in the group of patients who underwent CVC removal without anticoagulation, but 3 deaths occurred in this group within the first 7 days, reflecting 2.59% of the patients in this group.
The researchers concluded that symptomatic PE occurred at a low rate in patients with CVC-associated UE-DVT following CVC removal. They also concluded that early CVC removal did not show an association with increased PE risk, vs delayed or no CVC removal, in this population of patients. “Our data do not provide a compelling reason to delay CVC removal for the concern of PE,” the researchers wrote in their report.
Houghton DE, Billett HH, Gaddh M, et al. Risk of pulmonary emboli after removal of an upper extremity central catheter associated with a deep vein thrombosis. Blood Adv. 2021;5(14):2807-2812. doi:10.1182/bloodadvances.2021004698