High-dose corticosteroid associated with catheter-related thrombosis after allogeneic hematopoietic stem cell
Xiao-Hui Zhang1, Fei-Er Feng1, Wei Han1
1Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Insights
High-dose corticosteroids increase the risk of catheter-related thrombosis (CRT) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Further research is needed on thromboprophylaxis strategies for this vulnerable patient group.
Area of Science:
- Hematology
- Transplantation Medicine
- Vascular Medicine
Background:
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients face a heightened risk of thrombotic complications, particularly catheter-related thrombosis (CRT).
- The precise pathogenesis and contributing risk factors for CRT in this population remain incompletely understood.
- CRT poses a significant clinical challenge, impacting patient outcomes.
Purpose of the Study:
- To investigate the risk factors associated with catheter-related thrombosis (CRT) in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- To identify specific clinical parameters that predict the development of CRT in this high-risk cohort.
Main Methods:
- A retrospective nested case-control study was conducted in patients who underwent allo-HSCT.
- Thrombotic episodes were confirmed via duplex ultrasound, with cases and controls matched for key transplantation variables.
- Multivariate regression analysis was employed to identify independent risk factors for CRT.
Main Results:
- Out of 2896 patients, 40 (1.38%) developed CRT, with a median onset of 97 days post-catheter insertion.
- Central line-associated bloodstream infection rates were similar between CRT cases and controls.
- High-dose corticosteroid use was identified as an independent risk factor for CRT development.
Conclusions:
- High-dose corticosteroid use is significantly correlated with the onset of catheter-related thrombosis in allo-HSCT recipients.
- The findings suggest that CRT may adversely affect prognosis in these patients.
- Further investigation into the efficacy and safety of thromboprophylaxis strategies is warranted for this patient population.
Background:
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients are at an increased risk of thrombotic complications, most of which are catheter-related and present a substantial challenge. The incidence of CRT varies considerably depending on clinical factors. However, the underlying pathogenesis and risk factors remain unclear.
Methods:
We performed a retrospective nested case-control study in patients following allo-HSCT. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent CVC or PICC thrombosis confirmed via duplex ultrasound. Cases with CRT and controls were matched for time of HSCT, age at HSCT, donor source and type of insertion (CVCs or PICC).
Results:
During the 8-year period, catheters were placed in 2896 patients, with a total of 40 patients (1.38%) developed CRT, among which 11 were associated with CVCs and 29 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97days. Despite reports of an association between thrombosis and infection, central line-associated bloodstream infection was comparable between groups. No significant differences were noted in terms of primary disease, donor type, conditioning regimen or catheter type between the cases and controls. A multivariate regression analysis identified high-dose corticosteroids as independent risk factors for the development of CRT. CRT seems to negatively affect prognosis in allo-HSCT patients.
Conclusion:
In conclusion, we demonstrate that the use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population require further investigation.
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