1. Background

Central venous catheters (CVCs) are a leading cause of upper extremity deep vein thrombosis (UE DVT). There is little data on patients with acute leukemia (AL). Long term CVCs are required for chemotherapy in AL. Concomitant severe thrombocytopenia makes anticoagulation for CVC related thrombosis a challenge. Incidence of UE DVT has been reported to be increased in those with peripherally inserted central venous catheters (PICC lines) vs those with centrally inserted lines.

2. Aims

Our objective is to compare the incidence rate of VTE in leukemia inpatients with a PICC vs centrally-inserted CVC.

3. Methods

We reviewed 420 charts for AL inpatients requiring a PICC line admitted to Hematology at the University of Alberta Hospital between 2003-2013. Baseline patient characteristics were recorded. All venous thromboembolic events were objectively confirmed on imaging studies. Incidence of catheter associated thrombosis was calculated.

4. Results

420 patients were identified. We present the preliminary results of the 337 patients that met our inclusion criteria, and received at least one PICC line insertion. 305 (90%) had AML, 144 (43%) were smokers, 126 (37.4%) had cardiovascular risk factor, and only 14 (4.2%) had previous VTE. Overall, there were 634 PICC line insertions, with the 5FR dual lumen being the most commonly used PICC line (80%). Out of the 634 insertions, there were 65 (10%) new ipsilateral upper extremity DVTs, 54 (83%) of which developed acutely (<1month), and 44 (68%) in thrombocytopenic patients (platelet<50). 7 (1.1%) and 15 (2.4%) patients developed recurrent and concurrent VTEs, respectively. There was an incidence of 1.85 DVT per 1000 catheter days.

5. Conclusions

The incidence rate of DVT in our AL patients is higher than predicted for a general cancer patient population. This data will be compared to a similar cohort of AL inpatients presently being reviewed, who received a centrally-inserted CVC. Updated results will be included accordingly. Determining factors that are associated with a lower risk of DVT in this high bleeding risk population will be important to optimize patient care.

Disclosures

Wu:Leopharma: Membership on an entity's Board of Directors or advisory committees; Pfizer Canada: Membership on an entity's Board of Directors or advisory committees.

Topics:
catheters, central venous catheters, leukemia, acute, venous thromboembolism, peripherally inserted central catheter, deep vein thrombosis, thrombosis, anticoagulation, cancer, chemotherapy regimen

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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