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Catheter-related thrombosis

Definition
Central venous catheter thrombosis is a common complication of central venous catheter insertion characterized by thrombus formation around the site of the catheter.
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Pathophysiology
Central venous catheter thrombosis is caused by activation of the coagulation cascade and formation of thrombin and clot associated with an indwelling catheter. Circulatory stasis, vascular endothelial injury, and hypercoagulable states predispose to the development of thrombus.
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Disease course
Central venous catheter thrombosis may be asymptomatic or cause pain, swelling in the arm, shortness of breath, vena cava obstruction. Disease progression may lead to PE. Long-term sequelae may include postphlebitic syndrome.
2
Prognosis and risk of recurrence
The 28-day mortality rate in critically ill patients with central venous catheter thrombosis is estimated at 14.1%.
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Key sources
The following summarized guidelines for the evaluation and management of catheter-related thrombosis are prepared by our editorial team based on guidelines from the European Society of Medical Oncology (ESMO 2023; 2015), the International Initiative on Thrombosis and Cancer (ITAC 2022), the European Society for Vascular Surgery (ESVS 2021), the American Society of Hematology (ASH 2021), the Canadian Consensus Group on Cancer-Associated Thrombosis (CCG-CAT 2015), the Canadian Consensus Group on Venous Thromboembolism in Cancer (CCG-VTEC 2015), the International Society on Thrombosis and Haemostasis (ISTH 2014), the American Society of Clinical Oncology (ASCO 2013), and the American College of Chest Physicians (ACCP 2012).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging
As per CCG-CAT 2015 guidelines:
Obtain ultrasound in patients with suspected symptomatic catheter-related upper-extremity DVT.
B
Consider obtaining further diagnostic testing (such as contrast venography or CTV) in patients with negative ultrasound findings but with a high index of suspicion for catheter-related upper extremity DVT. Do not obtain serial ultrasound in this setting.
C
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2.Medical management

Anticoagulant therapy
As per ESMO 2023 guidelines:
Initiate anticoagulant therapy with LMWH, or alternatively VKAs or DOACs,
B
for a minimum of 3 months for the treatment of symptomatic catheter-related thromboses in patients with cancer.
B
Consider extending anticoagulation until catheter removal if the bleeding risk is low in patients with CRT received 3 months of anticoagulant treatment.
C

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3.Nonpharmacologic interventions

Catheter removal: as per ESMO 2023 guidelines, remove the catheter if it is not needed or is infected, anticoagulant treatment is contraindicated, or there is clinical deterioration due to thrombus extension despite treatment.
B

4.Specific circumstances

Pediatric patients: administer continuous infusion of UFH at 0.5 units/mL at 1 mL/hour in neonates and children with peripheral arterial catheters in situ.
A
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5.Preventative measures

Thromboprophylaxis: as per ESMO 2023 guidelines, do not administer routine pharmacological prophylaxis for CRT.
D

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