Risk of pulmonary emboli after removal of an upper extremity central catheter associated with a deep vein thrombosis

• Authors: Damon E Houghton, Mayo Clinic; Henny Heisler Billett, Montefiore Medical Center; Manila Gaddh, Emory University; Oluwatomiloba Onadeko, Emory University; Gemlyn George, University of Colorado, Aurora; Tzu-Fei Wang, University of Ottawa; Thein H Oo, University of Texas MD Anderson Cancer Cente; Mingen Feng, Medical College of Wisconsin; Mahua Dasgupta, Medical College of Wisconsin; Michael Jaglal, H Lee Moffitt Cancer Centre & Research Institute; Michael B Streiff, Johns Hopkins Med Inst; Pippa Simpson, Medical College of Wisconsin; Radhika Gali, Montefiore Medical Center; Lisa Baumann Kreuziger, Medical College of Wisconsin
• Journal Title: BLOOD ADVANCES
• Volume: Volume 5, Number 14
• Publisher: ELSEVIER | 2021-07-15, Pages 2807-2812
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1182/bloodadvances.2021004698
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; CENTRAL VENOUS CATHETERS; CANCER-PATIENTS; THROMBOEMBOLISM; ANTICOAGULATION; MANAGEMENT; GUIDANCE

Abstract

Standard treatment of catheter-associated upper extremity deep vein thrombosis (UEDVT) is anticoagulation, although catheters are often removed for this indication. The optimal time for catheter removal and whether the act and/or timing of catheter removal is associated with pulmonary embolism (PE) remain unknown. A retrospective cohort study was performed at 8 participating institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies and central venous catheter (CVC)-associated UE-DVT were included from 1 January 2010 through 31 December 2016. The primary outcome was objectively confirmed PE within 7 days of UE-DVT diagnosis in anticoagulated patients comparing early (≥48 hours) vs delayed (>48 hours) catheter removal. A total of 626 patients were included, among whom 480 were treated with anticoagulation. Among anticoagulated patients, 255 underwent early CVC removal, while 225 had delayed or no CVC removal; 146 patients received no anticoagulation, among whom 116 underwent CVC removal alone. PE within 7 days occurred in 2 patients (0.78%) with early removal compared with 1 patient (0.44%) with delayed or no CVC removal (P>.9). PE or any cause of death within 7 days occurred in 3 patients in both the early removal (1.18%) and delayed/no removal (1.33%) groups (P > .9). In patients treated with CVC removal only (no anticoagulation), there were no PEs but 3 deaths within 7 days. In patients with hematological malignancy and CVC-associated UE-DVT, early removal of CVCs was not associated with an increased risk of PE compared with delayed or no removal.