Catheter-Related Deep Vein Thrombosis in Critically Ill Cancer Patients

  • Sajid A. HaqueEmail author
  • Nisha K. Rathi
Reference work entry


Cancer and critical illness are predisposing factors for the development of catheter-related deep vein thrombosis. This chapter discusses specific catheter-related factors that increase the risk of thrombosis, as well as strategies for prophylaxis against the development of these vascular complications. Treatment options will also be covered, including management of the catheter and options for pharmacologic therapy. Finally, consideration will be given to concomitant thrombocytopenia, a frequent comorbid condition in patients with malignancy.


Cancer Critical illness Intensive care unit Catheter Thrombosis Deep vein thrombosis Catheter related thrombosis Pulmonary embolism Anticoagulation 


  1. 1.
    Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014;120(3):650–64.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Cook D, Crowther M, Meade M, et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med. 2005;33(7):1565–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Malato A, Dentali F, Siragusa S, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus = Trasfusione del sangue. 2015;13(4):559–68.PubMedGoogle Scholar
  4. 4.
    Khorana AA. Cancer-associated thrombosis: updates and controversies. Hematol Am Soc Hematol Educ Program. 2012;2012:626–30.CrossRefGoogle Scholar
  5. 5.
    Elyamany G, Alzahrani AM, Bukhary E. Cancer-associated thrombosis: an overview. Clinl Med Insights Oncol. 2014;8:129–37.Google Scholar
  6. 6.
    Wall C, Moore J, Thachil J. Catheter-related thrombosis: a practical approach. J Intensiv Care Soc. 2016;17(2):160–7.CrossRefGoogle Scholar
  7. 7.
    Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S–96S.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Eastridge BJ, Lefor AT. Complications of indwelling venous access devices in cancer patients. J Clin Oncol. 1995;13(1):233–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Luciani A, Clement O, Halimi P, et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology. 2001;220(3):655–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Cadman A, Lawrance JA, Fitzsimmons L, Spencer-Shaw A, Swindell R. To clot or not to clot? That is the question in central venous catheters. Clin Radiol. 2004;59(4):349–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Labourey JL, Lacroix P, Genet D, et al. Thrombotic complications of implanted central venous access devices: prospective evaluation. Bull Cancer. 2004;91(5):431–6.PubMedGoogle Scholar
  12. 12.
    Caers J, Fontaine C, Vinh-Hung V, et al. Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports. Support Care Cancer. 2005;13(5):325–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Saber W, Moua T, Williams EC, et al. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost. 2011;9(2):312–9.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Craft PS, May J, Dorigo A, Hoy C, Plant A. Hickman catheters: left-sided insertion, male gender, and obesity are associated with an increased risk of complications. Aust NZ J Med. 1996;26(1):33–9.CrossRefGoogle Scholar
  15. 15.
    Morazin F, Kriegel I, Asselain B, Falcou MC. Symptomatic thrombosis in central venous catheter in oncology: a predictive score? La Revue Med interne. 2005;26(4):273–9.CrossRefGoogle Scholar
  16. 16.
    Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med. 2011;37(2):284–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee AY, Levine MN, Butler G, et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol. 2006;24(9):1404–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Debourdeau P, Farge D, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost. 2013;11(1):71–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003;21(19):3665–75.PubMedCrossRefGoogle Scholar
  20. 20.
    Bern MM, Lokich JJ, Wallach SR, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med. 1990;112(6):423–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Couban S, Goodyear M, Burnell M, et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol. 2005;23(18):4063–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Heaton DC, Han DY, Inder A. Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis. Intern Med J. 2002;32(3):84–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Ruud E, Holmstrom H, De Lange C, Hogstad EM, Wesenberg F. Low-dose warfarin for the prevention of central line-associated thromboses in children with malignancies – a randomized, controlled study. Acta Paediatr. 2006;95(9):1053–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Young AM, Billingham LJ, Begum G, et al. Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial. Lancet. 2009;373(9663):567–74.PubMedCrossRefGoogle Scholar
  25. 25.
    De Cicco M, Matovic M, Balestreri L, et al. Early and short-term acenocumarine or dalteparin for the prevention of central vein catheter-related thrombosis in cancer patients: a randomized controlled study based on serial venographies. Ann Oncol. 2009;20(12):1936–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Abdelkefi A, Ben Othman T, Kammoun L, et al. Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial. Thromb Haemost. 2004;92(3):654–61.PubMedGoogle Scholar
  27. 27.
    Monreal M, Alastrue A, Rull M, et al. Upper extremity deep venous thrombosis in cancer patients with venous access devices – prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost. 1996;75(2):251–3.PubMedGoogle Scholar
  28. 28.
    Mismetti P, Mille D, Laporte S, et al. Low-molecular-weight heparin (nadroparin) and very low doses of warfarin in the prevention of upper extremity thrombosis in cancer patients with indwelling long-term central venous catheters: a pilot randomized trial. Haematologica. 2003;88(1):67–73.PubMedGoogle Scholar
  29. 29.
    Verso M, Agnelli G, Bertoglio S, et al. Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients. J Clin Oncol. 2005;23(18):4057–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Karthaus M, Kretzschmar A, Kroning H, et al. Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial. Ann Oncol. 2006;17(2):289–96.PubMedCrossRefGoogle Scholar
  31. 31.
    Niers TM, Di Nisio M, Klerk CP, Baarslag HJ, Buller HR, Biemond BJ. Prevention of catheter-related venous thrombosis with nadroparin in patients receiving chemotherapy for hematologic malignancies: a randomized, placebo-controlled study. J Thromb Haemost. 2007;5(9):1878–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Akl EA, Karmath G, Yosuico V, et al. Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters. Cochrane Database Syst Rev. 2007;(3):CD006468.Google Scholar
  33. 33.
    Kalmanti M, Germanakis J, Stiakaki E, et al. Prophylaxis with urokinase in pediatric oncology patients with central venous catheters. Pediatr Hematol Oncol. 2002;19(3):173–9.PubMedCrossRefGoogle Scholar
  34. 34.
    van Rooden CJ, Schippers EF, Guiot HF, et al. Prevention of coagulase-negative staphylococcal central venous catheter-related infection using urokinase rinses: a randomized double-blind controlled trial in patients with hematologic malignancies. J Clin Oncol. 2008;26(3):428–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Frank DA, Meuse J, Hirsch D, Ibrahim JG, van den Abbeele AD. The treatment and outcome of cancer patients with thromboses on central venous catheters. J Thromb Thrombolysis. 2000;10(3):271–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Mantha S, Laube E, Miao Y, et al. Safe and effective use of rivaroxaban for treatment of cancer-associated venous thromboembolic disease: a prospective cohort study. J Thromb Thrombolysis. 2017;43(2):166–71.PubMedCrossRefGoogle Scholar
  38. 38.
    Francis CW, Kessler CM, Goldhaber SZ, et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN study. J Thromb Haemost. 2015;13(6):1028–35.PubMedCrossRefGoogle Scholar
  39. 39.
    EINSTEIN Investigators, Bauersachs R, Berkowitz SD, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499–510.CrossRefGoogle Scholar
  40. 40.
    Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361(24):2342–52.PubMedCrossRefGoogle Scholar
  41. 41.
    Carrier M, Cameron C, Delluc A, Castellucci L, Khorana AA, Lee AY. Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res. 2014;134(6):1214–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest. 2015;147(2):475–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Wells PS, Theberge IA, Bowdridge JC, Forgie MA, Carrier M. PO-41 – rivaroxaban is effective therapy for high risk cancer patients with venous thromboembolic disease. Thromb Res. 2016;140(Suppl 1):S191–2.PubMedCrossRefGoogle Scholar
  44. 44.
    Savage KJ, Wells PS, Schulz V, et al. Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost. 1999;82(3):1008–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Kovacs MJ, Kahn SR, Rodger M, et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost. 2007;5(8):1650–3.PubMedCrossRefGoogle Scholar
  46. 46.
    Pucheu A, Dierhas M, Leduc B, et al. Fibrinolysis of deep venous thrombosis on implantable perfusion devices. Apropos of a consecutive series of 57 cases of thrombosis and 32 cases of fibrinolysis. Bull Cancer. 1996;83(4):293–9.PubMedGoogle Scholar
  47. 47.
    Schindler J, Bona RD, Chen HH, et al. Regional thrombolysis with urokinase for central venous catheter-related thrombosis in patients undergoing high-dose chemotherapy with autologous blood stem cell rescue. Clin Appl Thromb Hemost. 1999;5(1):25–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Mantha S, Miao Y, Wills J, Parameswaran R, Soff GA. Enoxaparin dose reduction for thrombocytopenia in patients with cancer: a quality assessment study. J Thromb Thrombolysis. 2017;43(4):514–8.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    National Comprehensive Cancer N. NCCN Guidelines Version 2.2018 Cancer-Associated Venous Thromboembolic Disease. 2018.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Critical CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations