International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer

Authors

  • P. DEBOURDEAU,

    1. D R S M Centre médical, Marseille
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    • These authors contributed equally to this work. The role of each author is specified in the Addendum. Reviewers are listed in the Acknowledgements section. These international guidelines were elaborated on the initiative of the ‘Groupe Francophone Thrombose et Cancer’ (GFTC) with the collaboration of the Academic Medical Center (AMC) and the University Medical Center Groningen (UMCG), the Netherlands, and the methodological support of the French Institute of Cancer (INCa).

  • D. FARGE,

    1. Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Internal Medicine and Vascular Disease Unit, Paris
    2. Paris 7 Diderot University, Sorbonne Paris Cité, INSERM U 796, Paris
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    • These authors contributed equally to this work. The role of each author is specified in the Addendum. Reviewers are listed in the Acknowledgements section. These international guidelines were elaborated on the initiative of the ‘Groupe Francophone Thrombose et Cancer’ (GFTC) with the collaboration of the Academic Medical Center (AMC) and the University Medical Center Groningen (UMCG), the Netherlands, and the methodological support of the French Institute of Cancer (INCa).

  • M. BECKERS,

    1. Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, UK
    2. Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
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  • C. BAGLIN,

    1. Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, UK
    2. Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
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  • R. M. BAUERSACHS,

    1. Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
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  • B. BRENNER,

    1. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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  • D. BRILHANTE,

    1. Serviço de Imuno Hemoterapia, Departamento de Hematologia, Instituto Português de Oncologia Lisboa Francisco Gentil, Lisboa, Portugal
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  • A. FALANGA,

    1. Division of Immunohematology and Transfusion Medicine, Department of Oncology-Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
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  • G. T. GEROTZAFIAS,

    1. Service d’Hématologie Biologique, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
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  • N. HAIM,

    1. Division of Oncology, Rambam Health Care Campus, Haifa, Israel
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  • A. K. KAKKAR,

    1. Thrombosis Research Institute, Queen Mary University of London, London, UK
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  • A. A. KHORANA,

    1. James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, NY, USA
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  • R. LECUMBERRI,

    1. Department of Haematology, University Clinic of Navarra, Pamplona, Spain
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  • M. MANDALA,

    1. Unit of Medical Oncology, Department of Oncology and Haematology, Ospedali Riuniti, Bergamo, Italy
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  • M. MARTY,

    1. Centre des Innovations Thérapeutiques en Oncologie et Hématologie (CITOH), Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
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  • M. MONREAL,

    1. Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
    2. The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
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  • S. A. MOUSA,

    1. King Saud University, Riyadh, Saudi Arabia
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  • S. NOBLE,

    1. Department of Palliative Medicine, Cardiff University, Royal Gwent Hospital, Newport, UK
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  • I. PABINGER,

    1. Division of Haematology and Haemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
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  • P. PRANDONI,

    1. Department of Cardiothoracic and Vascular Sciences, Thromboembolism Unit, University of Padua, Padua, Italy
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  • M. H. PRINS,

    1. Department of Epidemiology, Care and Public Health Research Institutes, University of Maastricht, Maastricht, the Netherlands
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  • M. H. QARI,

    1. Department of Hematology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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  • M. B. STREIFF,

    1. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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  • K. SYRIGOS,

    1. Oncology Unit GPP, Athens School of Medicine, Sotiria General Hospital, Athens, Greece
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  • H. R. BÜLLER,

    1. Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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    • These authors contributed equally to this work. The role of each author is specified in the Addendum. Reviewers are listed in the Acknowledgements section. These international guidelines were elaborated on the initiative of the ‘Groupe Francophone Thrombose et Cancer’ (GFTC) with the collaboration of the Academic Medical Center (AMC) and the University Medical Center Groningen (UMCG), the Netherlands, and the methodological support of the French Institute of Cancer (INCa).

  • H. BOUNAMEAUX

    1. Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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    • These authors contributed equally to this work. The role of each author is specified in the Addendum. Reviewers are listed in the Acknowledgements section. These international guidelines were elaborated on the initiative of the ‘Groupe Francophone Thrombose et Cancer’ (GFTC) with the collaboration of the Academic Medical Center (AMC) and the University Medical Center Groningen (UMCG), the Netherlands, and the methodological support of the French Institute of Cancer (INCa).


Dominique Farge, Assistance Publique- Hôpitaux de Paris, Saint-Louis Hospital, Internal Medicine and Vascular Disease Unit, 1 avenue Claude-Vellefaux, 75010 Paris, France.
and
Paris 7 Diderot University, Sorbonne Paris Cité, INSERM U 796, Paris, France.
Tel.: +33 (0)1 42 49 97 68; fax: +33 (0)1 42 49 94 78.
E-mail: dominique.farge-bancel@sls.ap-hop-paris.fr

Abstract

Summary.  Background: Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives: To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. Methods: An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. Results: For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3 months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman® catheter vs. closed-ended catheter with a valve like the Groshong® catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. Conclusion: Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.

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