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3546 Incidence of Catheter-Related Venous Thromboembolism Events in Acute Leukemia patients; A Comparative, Retrospective Study of the Safety of Peripherally-Inserted Vs Centrally-Inserted Central Venous Catheters 

Pathophysiology of Thrombosis
Program: Oral and Poster Abstracts
Session: 331. Pathophysiology of Thrombosis: Poster III
Monday, December 7, 2015, 6:00 PM-8:00 PM
Hall A, Level 2 (Orange County Convention Center)

Mohammad Refaei, MD, BSc, MSc1, Bruna Fernandes2*, Joseph Brandwein, MD, FRCPC3*, M. Dawn Goodyear, MD4,5 and Cynthia M Wu, MD, FRCPC6

1Core Internal Medicine, University of Alberta, Edmonton, AB, Canada
2Nursing Department, University of Alberta, Edmonton, AB, Canada
3University of Alberta, Edmonton, AB, Canada
4Division of Hematology and Hematologic Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
5Division of Hematology, University of Calgary, Calgary, AB, Canada
6Division of Hematology, University of Alberta, Edmonton, AB, Canada

1. Background

Central venous catheters (CVCs) are a leading cause of upper extremity deep vein thrombosis (UE DVT).  There is little data on patients with acute leukemia (AL).  Long term CVCs are required for chemotherapy in AL.  Concomitant severe thrombocytopenia makes anticoagulation for CVC related thrombosis a challenge.  Incidence of UE DVT has been reported to be increased in those with peripherally inserted central venous catheters (PICC lines) vs those with centrally inserted lines.     

2 . Aims

Our objective is to compare the incidence rate of VTE in leukemia inpatients with a PICC vs centrally-inserted CVC. 

3. Methods

We reviewed 420 charts for AL inpatients requiring a PICC line admitted to Hematology at the University of Alberta Hospital between 2003-2013. Baseline patient characteristics were recorded.  All venous thromboembolic events were objectively confirmed on imaging studies. Incidence of catheter associated thrombosis was calculated.

4. Results

420 patients were identified. We present the preliminary results of the 337 patients that met our inclusion criteria, and received at least one PICC line insertion. 305 (90%) had AML, 144 (43%) were smokers, 126 (37.4%) had cardiovascular risk factor, and only 14 (4.2%) had previous VTE. Overall, there were 634 PICC line insertions, with the 5FR dual lumen being the most commonly used PICC line (80%). Out of the 634 insertions, there were 65 (10%) new ipsilateral upper extremity DVTs, 54 (83%) of which developed acutely (<1month), and 44 (68%) in thrombocytopenic patients (platelet<50). 7 (1.1%) and 15 (2.4%) patients developed recurrent and concurrent VTEs, respectively. There was an incidence of 1.85 DVT per 1000 catheter days.

5. Conclusions

The incidence rate of DVT in our AL patients is higher than predicted for a general cancer patient population. This data will be compared to a similar cohort of AL inpatients presently being reviewed, who received a centrally-inserted CVC. Updated results will be included accordingly.  Determining factors that are associated with a lower risk of DVT in this high bleeding risk population will be important to optimize patient care.

Disclosures: Wu: Leopharma: Membership on an entity’s Board of Directors or advisory committees ; Pfizer Canada: Membership on an entity’s Board of Directors or advisory committees .

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*signifies non-member of ASH