Catheter-related thrombosis: a critical review

The use of indwelling central venous catheters (CVCs) has improved the management of patients with cancer. However, these devices can be complicated by thrombosis because of their procoagulant state, therapies, immobility, and comorbidities. In addition, an indwelling CVC is a foreign body within the blood stream and can cause a mechanical injury during its insertion. Female sex, age, weight, primitive tumor (ovarian and lung adenocarcinoma), factor V Leiden, increased plasma levels of homocysteine, previous CVC risk of thrombosis, and chemotherapy as well as the material of the catheter, its tip location, the side of implantation insertion, and insertion time and attempts have shown relationships with higher rates of thrombosis. Actual data report a lower incidence of asymptomatic and symptomatic thrombosis (5%). This could be explained by technical improvement, different patient populations, and methodologic limitations in studies. Prophylaxis with heparins and coumarins are not supported by actual reliable evidence. The best treatment is not defined, but thrombolysis could be a simple, safe, and effective method that could decrease the rate of postphlebotic syndrome. A systematic phase III clinical trial should be performed to clarify these issues. Central venous catheter infection, postphlebitic syndrome, and pulmonary embolism are the most relevant complications of catheter-related thrombosis.