Incidence and clinical progression of asymptomatic peripherally inserted central catheter - related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study

Mattia Cominacini; Sergio De Marchi; Federica Tosi; Elia Piccinno; Alessandro Dal Corso; Elisa Dalla Grana; Francesca Stefani; Luca Dalle Carbonare

doi:10.1016/j.rpth.2024.102391

Incidence and clinical progression of asymptomatic peripherally inserted central catheter - related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study

Res Pract Thromb Haemost. 2024 Mar 27;8(3):102391. doi: 10.1016/j.rpth.2024.102391. eCollection 2024 Mar.

Authors

Mattia Cominacini¹, Sergio De Marchi², Federica Tosi³, Elia Piccinno³, Alessandro Dal Corso¹, Elisa Dalla Grana¹, Francesca Stefani³, Luca Dalle Carbonare¹

Affiliations

¹ Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy.
² Department of Angiology, Integrated University Hospital of Verona, Verona, Italy.
³ Department of Emergency Medicine, Integrated University Hospital of Verona, Verona, Italy.

Abstract

Background: Managing central venous catheters in patients with neoplasms is challenging, and peripherally inserted central catheter PORT (PICC-PORT) has emerged as a promising option for safety and efficacy. However, understanding the clinical progression of catheter-related thrombosis (CRT) in cancer patients with central venous catheters remains limited, especially in certain neoplasm types associated with a higher risk of venous thrombosis.

Objectives: This study aims to assess the effectiveness of ultrasound-guided management in detecting and treating asymptomatic CRT in cancer patients with PICC.

Methods: In this prospective cohort study of 120 patients with solid neoplasms receiving chemotherapy, we investigated the incidence of isolated upper-extremity superficial vein thrombosis, upper-extremity deep vein thrombosis, and fibrin sheath formation through ultrasound follow-up at 30 and 90 days after catheter insertion. We analyzed risk factors associated with CRT and compared incidence rates between PICC-PORT and traditional PICC.

Results: Among the cohort, 69 patients (57.5%) had high-risk thromboembolic neoplasm, and 31 cases (25.8%) of CRT were observed, mostly within 30 days, with only 7 cases (22.6%) showing symptoms. Traditional PICC use (odds ratio, 5.86; 95% CI, 1.14-30) and high-risk thromboembolic neoplasm (odds ratio, 4.46; 95% CI, 1.26-15.81) were identified as independent risk factors for CRT.

Conclusion: The majority of CRT present asymptomatically within the first 30 days of venous catheter insertion in patients with solid neoplasms. Ultrasound follow-up is valuable for detecting asymptomatic CRT. The risk of CRT was lower with PICC-PORT than with PICC. Additionally, the risk of CRT was found to be higher in patients with high-risk thromboembolic neoplasms. It is crucial for larger studies to confirm the utility of treating asymptomatic thromboses and isolated superficial thrombosis.

Keywords: Doppler; PICC line catheterization; central venous catheter thrombosis; neoplasms; secondary; ultrasound imaging; upper exremitiy deep vein thrombosis; vascular access devices.