Thromboprophylaxis in Patients Receiving Chemotherapy — NEJM
Correspondence
Thromboprophylaxis in Patients Receiving Chemotherapy
N Engl J Med 2012; 366:1839-1840May 10, 2012
- Article
To the Editor:
In their article on the results of the SAVE-ONCO study (ClinicalTrials.gov number, NCT00694382), which showed that semuloparin reduced the risks of deep-vein thrombosis in the lower or upper limbs and pulmonary embolism among patients receiving chemotherapy for cancer, Agnelli and colleagues (Feb. 16 issue)1 do not mention the development of central-venous-catheter thrombosis. Indeed, deep-vein thrombosis related to a central venous catheter is a frequent complication, reported in 4% of patients with symptomatic events and 20 to 30% of patients with asymptomatic events detected by means of venography or ultrasonography; this complication is associated with the risk of pulmonary embolism and loss of central venous access.2 A recent Cochrane review did not show any efficacy of heparins or vitamin K antagonists for the prevention of central-venous-catheter thrombosis.3 Accordingly, national guidelines mention no prophylactic treatment; specifically, they recommend no prophylactic doses of low-molecular-weight heparin or low-dose warfarin.2 Only the placement of the distal tip of the central venous catheter at the junction between the superior vena cava and the right atrium, and insertion on the right side are indicated.2,4 Therefore, was central-venous-catheter thrombosis observed in the study, and was semuloparin an effective prophylactic treatment?Claude Bachmeyer, M.D.No potential conflict of interest relevant to this letter was reported.
Jean-Charles Pellen, M.D.
Tenon Hospital, Paris, France
claude.bachmeyer@tnn. aphp. fr
4 ReferencesAuthor/Editor Response
Bachmeyer and Pellen wonder whether central venous catheter–related thrombosis was observed in the study and whether semuloparin was an effective prophylactic treatment for this complication. In our study, a central venous catheter was present in 19.7% of patients in the semuloparin group and 18.8% of patients in the placebo group. Symptomatic deep-vein thrombosis of the upper limbs, including central-venous-catheter thrombosis, was part of the composite primary efficacy outcome. During the efficacy analysis period, symptomatic deep-vein thrombosis of the upper limbs occurred in 9 of 1604 patients in the placebo group (0.6%) and 3 of 1608 patients in the semuloparin group (0.2%) (hazard ratio, 0.33; 95% confidence interval, 0.07 to 1.18). All these patients had a central venous catheter. The risk reduction in deep-vein thrombosis of the upper limbs (including central-venous-catheter thrombosis) associated with semuloparin was consistent with the risk reduction in the other components of the composite primary efficacy outcome of the study, but the number of observed events is small.
Giancarlo Agnelli, M.D.
University of Perugia, Perugia, Italy
agnellig@unipg.it
Alexander G.G. Turpie, M.D.
McMaster University, Hamilton, ON, Canada
