comprehensive review Catheter-Related Thrombosis: A Critical Review Jesús Domingo Acedo Sánchez, Jaime Feliu Batlle, Jorge Barriuso Feijoo Key words: Chemotherapy, Lung adenocarcinoma, Ovarian adenocarcinoma, Postphlebitic syndrome Abstract The use of indwelling central venous catheters (CVCs) has improved the management of patients with cancer. However, these devices can be complicated by thrombosis because of their procoagulant state, therapies, immobility, and comorbidities. In addition, an indwelling CVC is a foreign body within the blood stream and can cause a mechanical injury during its insertion. Female sex, age, weight, primitive tumor (ovarian and lung adenocarcinoma), factor V Leiden, increased plasma levels of homocysteine, previous CVC risk of thrombosis, and chemotherapy as well as the material of the catheter, its tip location, the side of implantation insertion, and insertion time and attempts have shown relationships with higher rates of thrombosis. Actual data report a lower incidence of asymptomatic and symptomatic thrombosis (5%). This could be explained by technical improvement, different patient populations, and methodologic limitations in studies. Prophylaxis with heparins and coumarins are not supported by actual reliable evidence. The best treatment is not defined, but thrombolysis could be a simple, safe, and effective method that could decrease the rate of postphlebotic syndrome. A systematic phase III clinical trial should be performed to clarify these issues. Central venous catheter infection, postphlebitic syndrome, and pulmonary embolism are the most relevant complications of catheter-related thrombosis. Medical Oncology Department, La Paz Hospital, Madrid, Spain Address for correspondence: Jesús Domingo Acedo Sánchez, Medical Oncology Department, La Paz Hospital, Paseo de la Castellana, 261, Madrid, Spain 28046 Fax: 3491-727-71-18; e-mail: jedoacsa@yahoo.es Submitted: Jul 31, 2006; Revised: Oct 23, 2006; Accepted: Jan 29, 2007 Supportive Cancer Therapy, Vol 4, No 3, 145-151, 2007 Volume 4, Number 3 • May 2007 145 Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1543-2912, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400. Introduction The use of indwelling central venous catheters (CVCs) has improved the management of patients with cancer. These devices simplify the administration of chemotherapy, allowing bone marrow transplantation, parenteral nutrition, intravenous medication, and the infusion of blood products. However, these devices can be complicated by developing pneumothorax and hemorrhage at the time of insertion or later on by developing thrombosis, infection, malfunction, or mechanical failure. 1 Patients with cancer are prone to develop thrombotic events because of the release of procoagulant fac- tors by tumor cells and the response of macrophage lineage and endothelial cells, with the consistent release of humoral factors such as tumor necrosis factor, interleukin (IL)–1, IL-6, or vascular endothelial growth factor, which mediate a tenden- cy to form clots. 2,3 Other contributing factors to the risk of vascular events are chemotherapy, surgery, age of the patient, primary tumor site, immobility, and indwelling CVCs. Catheter-related thrombosis is commonly asymptomatic. Symptomatic catheter-related thrombosis can manifest as arm, neck, or head swelling or pain; headache; numbness or erythema of the extremity; phlegmasia; venous distension; or jaw pain. 1 Moreover, catheter-related thrombosis can modify the treatment compliance 4 or induce postphlebitic syndrome, pulmonary emboli (PE), and infection of the catheter. There is an important