Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 36; no. 10; pp. 885 - 889
• Main Authors: ABDELKEFI, A, BEN ROMDHANE, N, LADEB, F, BEN ABDELADHIM, A, KRIAA, A, CHELLI, M, TORJMAN, L, LADEB, S, BEN OTHMAN, T, LAKHAL, A, GUERMAZI, S, BEN HASSEN, A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.11.2005
• Subjects: Abnormalities; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antithrombin; Biological and medical sciences; Blood clot; Blood coagulation; Blood Coagulation Factors - genetics; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Catheterization - adverse effects; Catheterization, Central Venous - adverse effects; Catheters; Coagulation factors; Complications and side effects; Diagnosis; Emergency and intensive care: techniques, logistics; Factor V; Family Health; Female; Genetic Predisposition to Disease; Health aspects; Health services; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Intensive care medicine; Male; Markers; Medical instruments; Medical sciences; Middle Aged; Mutation; Organ transplant recipients; Patients; Physicians; Polyurethane; Polyurethane resins; Prevalence; Prevention; Prospective Studies; Protein C; Protein deficiency; Protein S; Proteins; Prothrombin; Prothrombin gene; Risk factors; Stem cell transplantation; Stem cells; Thromboembolism; Thrombophilia - complications; Thrombophilia - diagnosis; Thrombophilia - genetics; Thrombosis; Thrombosis - etiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplants; Transplants & implants; Tunisia; Africa; Human; inherited prothrombotic abnormalities; Prevalence; Catheterization; Hematology; Stem cell; Catheter; Hematopoietic cell; Homograft; Cardiovascular disease; central venous catheter; Hereditary; Epidemiology; Central vein; Genetic disease; Venous disease; prothrombotic state; Vascular disease; thrombosis; Graft; Complication; haematopoietic stem cell transplant; Venous thrombosis; Public health
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705156

In this prospective study, we assessed the incidence of central venous catheter (CVC)-related thrombosis in haematopoietic stem cell transplant (HSCT) recipients. We determined the contribution of inherited prothrombotic abnormalities in blood coagulation to CVC-related thrombosis in these patients. The study was conducted between May 2002 and September 2004. CVCs were externalized, nontunneled, polyurethane double lumen catheters. Before catheter insertion, laboratory prothrombotic markers included factor V Leiden, the prothrombin gene Gly20210A mutation, plasma antithrombin levels, and protein C and S activity. All patients were systematically examined by ultrasonography just before, or <24 h after, catheter removal, and in case of clinical signs of thrombosis. A total of 171 patients were included during the 28-month study period. Five (2.9%) and three (1.7%) patients had evidence of protein C and protein S deficiency, respectively. Only one patient had an antithrombin deficiency (0.6%). In total, 10 patients (5.8%) were heterozygous for the factor V Leiden mutation, and one patient had heterozygous prothrombin G20210A mutation (0.6%). We observed a CVC-related thrombosis in 13 patients (7.6%). Thrombosis was diagnosed in four out of 20 patients (20%) with a inherited prothrombotic abnormality compared to nine of 151 patients (6%) who did not have a thrombophilic marker (relative risk 3.3 CI 95% 1.1-9.9). Our results suggest that inherited prothrombotic abnormalities contribute substantially to CVC-related thrombosis in HSCT recipients. In view of physicians' reluctance to prescribe prophylactic anticoagulant treatment in these patients, a priori determination of inherited prothrombotic abnormalities may form a basis to guide these treatment decisions.