Outcomes of Central Venous Catheter Associated Upper Extremity Deep Vein Thrombosis in Cancer Patents
Bibliographic record
Abstract
Abstract Introduction: Upper extremity deep vein thrombosis (UEDVT) is a frequent complication of central venous catheters in cancer patients. Anticoagulation with low molecular weight heparin (LMWH) for a minimum of 3 months is the currently recommended treatment for catheter-related UEDVT in cancer patients. Following catheter removal and a minimum of three months of anticoagulant therapy, the risk of recurrence of VTE is likely to be low and it might be reasonable to discontinue anticoagulant therapy. However, there are no data available to support these hypotheses. Therefore, we sought to assess the efficacy and safety of LMWH for the treatment of catheter-related UEDVT in cancer patients and determine the risk of recurrence of VTE after discontinuation of anticoagulation. Material and methods: A retrospective single center cohort study including consecutive cancer outpatients assessed between July 2008 and December 2012 for the management of symptomatic central venous catheter associated proximal UEDVT was conducted. Results: A total of 99 patients were included. Among them, 89 were treated with one month of full therapeutic weight-adjusted dose of LMWH followed by an intermediate dose. A prophylactic dose of LMWH was given after 3 (n=8), 6 (n=4), or 12 (n=1) months of intermediate dosing of LMWH. The remainder patients continued with intermediate dose of LMWH until discontinuation or last follow up. Median duration of anticoagulation was 124 days (range 40 to 1849). No recurrent VTE and two major bleeding episodes occurred during the first 3 months of treatment. Among the 13 patients who were receiving prophylactic doses of LMWH after completion of 3, 6 or 12 months at full and intermediate doses, 2 (15.4%) had a recurrent VTE event. Others did not recurred while on treatment. Eighty-three patients discontinued anticoagulation and 80 could be followed-up after anticoagulation discontinuation for a median of 632 days (range 6 to 2495). Central venous line was pulled out in 77 patients (96.2%). Five recurrences were observed during follow up. The cumulative probability of recurrent VTE was higher in patients whose cancer was active at the time of anticoagulation discontinuation as compared with those in remission (22.2% (95% CI: 0 to 40.6) vs. 2.3% (95% CI: 0 to 6.7)) (Figure 1). Conclusion: LMWH can safely be used to treat catheter associated proximal UEDVT in the setting of cancer. In patients whose central venous line has been pulled and cancer is in remission, anticoagulation therapy can be safely discontinued. Figure 1: cumulative probability of recurrence according to cancer status at the time of anticoagulation discontinuation Disclosures No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".