Long term anticoagulation for Catheter-Related deep vein thrombosis of the upper extremities in women with cancer: retrospective analysis of effectiveness and safety outcomes.

Abstract

Catheter-related upper extremity deep vein thrombosis (CRT-UEDVT) is a possible complication in patients with cancer carrying a central venous catheter. Anticoagulation is the primary treatment, but optimal duration is unclear. This study evaluated effectiveness and safety of different lengths of anticoagulation in women with cancer and CRT-UEDVT. We conducted a retrospective analysis on women ≥ 18 years-old, who had active cancer and had received anticoagulant treatment for CRT-UEDVT. Effectiveness was assessed in terms of VTE recurrence and thrombosis recanalization. Safety was determined by assessing major bleedings (MB) and clinically relevant non-major bleedings (CRNMB) during treatment. A total of 113 women where included. All of them had completed at least 3 months of anticoagulant therapy, while 106 and 97 had completed 6 and 12 months of anticoagulant therapy, respectively. The median follow-up was 568.5 days (IQR 300-910). Patients primarily presented with ovarian, breast, and endometrial cancers. Anticoagulant therapy was mainly parenteral during the initial 3 months and between 3 and 6 months, shifting predominantly to direct oral anticoagulants during months 6-12. The annual VTE recurrence rate was 0.5%. The annual rate of MB and CRNMB was 1.9%. Complete thrombosis recanalization was achieved in 52.0%, 69.1%, and 87.3% of patients at 3, 6, and 12 months, respectively. Our study provides interesting insights into the management and clinical outcomes of women with cancer and CRT-UEDVT. Prospective studies are needed to fully understand advantages and disadvantages of different lengths of anticoagulation in this set of patients.