Thromboprophylaxis appeared to reduce the risk of venous thromboembolism (VTE) in patients with sickle cell disease (SCD) who had central venous access devices (CVADs), according to a new study published in the Journal of Clinical Medicine.
Although CVADs are frequently used in patients with SCD to enable transfusions and iron chelation treatment, CVADs themselves can contribute to VTE risk, the study investigators explained in their report. The investigators also noted that the role of thromboprophylaxis is unclear for this patient population, and they developed this study with an aim of assessing the impact of thromboprophylaxis on VTE risk in this setting. An additional study aim was to identify factors related to VTE risk in this patient population.
This retrospective cohort study included adult patients with SCD who had a CVAD that was intended for chronic use, which was defined as ≥3 months. Patients were recruited from 2 SCD centers in Canada and France. Numerous characteristics obtained from patients’ electronic health records were included in analyses of risk factors. These involved patient-, catheter-, device-, and treatment-related VTE risk factors, in addition to details regarding any thromboprophylaxis used during the time of CVAD insertion.
From a total of 949 patients, 49 patients had a CVAD. VTE prophylaxis was used in 24 of these patients and was not used in the other 25 patients. Types of thromboprophylaxis that were used varied across the population. The mean age of patients receiving thromboprophylaxis was 31.9 years (SD, 9.1), and it was 33.8 years (SD, 9.1) for patients without thromboprophylaxis. Hydroxyurea use was common, occurring in 50% of patients receiving thromboprophylaxis and in 68% of patients without thromboprophylaxis.
In patients without thromboprophylaxis, VTE rates were higher than in patients receiving thromboprophylaxis, with a rate ratio (RR) of 4.0 (95% CI, 1.2-12.6; P =.02) in univariate analysis. VTE was less frequent with hydroxyurea than without it (RR, 20.5; 95% CI, 6.4-65.3; P <.001).
Among subtypes of CVADs, when compared with Port-a-Cath, Vortex and Xcela Power implantable CVADs were linked to a higher rate of VTE (RR, 58.2; 95% CI, 15.0-225.0; P <.001). Peripherally inserted central catheter (PICC) lines also appeared to be associated with a higher rate of VTE than Port-a-Cath devices were (RR, 5.8; 95% CI, 1.3-25.9; P =.02). In a multivariable analysis, factors that were identified as independently related to VTE risk were thromboprophylaxis, hydroxyurea use, and subtype of CVAD.
“In conclusion, the results are highly suggestive of the protective effect of thromboprophylaxis and hydroxyurea against thrombosis in patients with SCD and CVAD,” the study investigators wrote in their report. However, they indicated more research is needed to evaluate these findings and that a pilot study is underway.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Forté S, De Luna G, Abdulrehman J, et al. Thromboprophylaxis reduced venous thromboembolism in sickle cell patients with central venous access devices: a retrospective cohort study. J Clin Med. 2022;11(5):1193. doi:10.3390/jcm11051193