Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study

Cancer Med. 2017 Nov;6(11):2732-2744. doi: 10.1002/cam4.1201. Epub 2017 Oct 4.


Previous epidemiologic studies investigating central venous catheter (CVC)-related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)-CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double-blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow-up. Symptomatic DUS-CRT were treated by anticoagulants. D-Dimers, thrombin generation, and platelet-derived microparticles were measured before and 2 days after CVC placement. In DUS-CRT patients, a nested case-control study analyzed the role of thrombophilia. Among 524 patients, the DUS-CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient-months). Ten/14 symptomatic DUS-CRT were detected on double-blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS-CRT. Age >50 years (OR, 1.80; 95% CI, 1.01-3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46-4.76) and comorbidities (OR, 2.05; 95% CI, 1.18-3.56) were associated with DUS-CRT. No biomarkers was found to predict DUS-CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46-4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32-4.96) remained the only significant DUS-CRT risk factors. Thrombophilia did not account for DUS-CRT. Only clinical parameters identified high risk DUS-CRT patients who may be considered for thromboprophylaxis.

Keywords: Breast cancer; central venous catheter; chemotherapy; risk factors; venous thromboembolism.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Age Factors
  • Asymptomatic Diseases / epidemiology
  • Blood Platelets
  • Body Mass Index
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Breast Neoplasms, Male / drug therapy
  • Breast Neoplasms, Male / pathology
  • Carcinoma, Ductal, Breast / drug therapy*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Lobular / drug therapy*
  • Carcinoma, Lobular / pathology
  • Case-Control Studies
  • Cell-Derived Microparticles
  • Central Venous Catheters / adverse effects*
  • Comorbidity
  • Double-Blind Method
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Thrombin / biosynthesis
  • Thromboembolism / diagnostic imaging
  • Thromboembolism / epidemiology*
  • Thromboembolism / etiology*
  • Thrombophilia / epidemiology*
  • Ultrasonography, Doppler


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Thrombin