Peri-procedural anticoagulation management for central venous catheter insertion in persons with cancer

Anticoagulation use is common in persons with cancer (PWC) due to a high prevalence of venous thromboembolism (VTE) and atrial fibrillation (AF). These PWC often require central venous catheters (CVC) for administration of chemotherapy, intravenous fluids, and blood products however the ideal peri-procedural anticoagulation management strategy for tunneled and port CVC insertion is unknown. Peri-procedural anticoagulation interruption is the de facto standard of care strategy for general procedures in the general population, however may not apply to tunneled and port CVC insertion in PWC as these are specialized low risk radiologically guided procedures but conducted in a high risk population. Alternatively, peri-procedural anticoagulation continuation, as conducted in the procedurally similar cardiac device insertion may be the strategy of choice given its simplicity and potentially equal or lower risk of complications. Improper peri-procedural anticoagulation management may expose PWC to bleeding and thrombotic risks, with the risks higher in those on anticoagulation for VTE compared to those on anticoagulation for AF. Despite the limited data available, guidelines regarding non-tunneled CVC insertion are consistent, endorsing peri-procedural anticoagulation continuation. Guidelines regarding peri-procedural anticoagulation for tunneled and port CVC insertion however are conflicting, with some endorsing interruption, and others continuation. With the incidence of cancer, thrombosis, and CVC use increasing, peri-procedural anticoagulation management for CVC insertion is expected to continue to become more frequent over time. High-quality data regarding peri-procedural anticoagulation management for tunneled and port CVC insertion in PWC are needed to standardize practice, streamline care, and mitigate complications in this high-risk population.