Central venous catheter related thrombosis in haematology patients and prediction of risk by screening with Doppler‐ultrasound

Summary. Patients with a central venous catheter (CVC) who receive intensive chemotherapy or a stem cell transplantation for haematological disease are at risk for developing CVC‐related thrombosis. To study the incidence of thrombosis, 105 consecutive patients underwent serial Doppler‐ultrasound and we evaluated whether clinically manifest thrombosis could be predicted by screening with Doppler‐ultrasound. Patients with subclavian or jugular inserted CVCs were clinically assessed each day for signs and symptoms of thrombosis. Additional Doppler‐ultrasound screens were performed weekly by an independent physician in all patients until CVC removal. Doppler‐ultrasound recordings were assessed by two blinded observers. In cases of clinically suspected thrombosis, the attending physicians followed routine diagnostic and therapeutic procedures. The overall cumulative incidence of CVC‐related thrombosis was 28·6% (30 of 105 patients). Of the 30 patients with thrombosis, 26 had subclinical thrombosis by Doppler‐ultrasound, nine of whom developed clinically manifest thrombosis later. Four patients had clinically manifest thrombosis without prior abnormal Doppler‐ultrasound. In cases of subclinical thrombosis the risk of developing symptomatic disease increased sevenfold (34·6% vs. 5·1%). Doppler‐ultrasound screening may be useful to identify those patients that are at high and low risk for clinically manifest CVC‐related thrombosis.