Should cancer patients receive thromboprophylaxis to prevent catheter-related upper limb deep vein thrombosis?

Excerpt

Long-term central venous catheters have considerably improved the management of cancer patients. However, their use has been associated with the occurrence of upper limb deep vein thrombosis (DVT), especially in those patients who require the administration of chemotherapy [1]. The true incidence of upper limb DVT in patients with central venous lines is difficult to estimate, since data from literature are somehow conflicting. In the absence of thromboprophylaxis, Bern et al. [2] found an incidence of DVT, as shown by phlebography, of 37%. Monreal et al. [3] found an even higher incidence. Conversely, in recent case series and randomized studies that adopted ultrasonography or other non-invasive methods to detect upper limb DVT, a much lower rate of this thrombotic disorder has been reported [4‐8]. Along with the lower sensitivity of objective non-invasive methods in comparison with phlebography, the introduction of new texture and coating of catheters, as well as new procedures to reduce their invasiveness is likely to account for discrepancies between older and more recent studies [9]. …