British journal of haematology
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Multicenter Study
Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study.
This prospective, observational and multicentre study assessed the incidence of, and risk factors for, symptomatic venous thrombotic complications after central venous catheter (CVC) positioning in patients with haematological malignancies. A total of 458 consecutive CVC insertions were registered in 416 patients (81.2% of whom had severe thrombocytopenia). Over the observation period (3 months or up to catheter removal), the incidence of events was: CVC-related deep vein thrombosis (DVT), 1.5%; lower limb DVT, 0.4%; pulmonary embolism (PE), 1.3%; fatal PE, 0.6%; CVC-related superficial thrombophlebitis, 3.9%; CVC-occlusion/malfunction of thrombotic origin, 6.1%; major arterial events, 1.1%. ⋯ No factor helped to predict venous thrombotic complications: only thrombocytopenia was associated with a weak trend for a reduced risk (odds ratio 0.52; 95% confidence interval 0.26-1.07). No severe bleeding was observed in those patients who received antithrombotic prophylaxis. This study shows that the impact on clinical practice of symptomatic CVC-related thrombotic complications is not negligible in patients with haematological malignancies.
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Multicenter Study
Reduced efficacy of clinical probability score and D-dimer assay in elderly subjects suspected of having deep vein thrombosis.
The combined strategy of a pretest clinical probability (PCP) score and D-dimer has shown to be of value in the diagnosis of deep vein thrombosis (DVT). As D-dimer concentrations increase with age, the effect of age on the usefulness of this strategy was retrospectively investigated in outpatients suspected of having DVT. In all patients, participants of a prospective management trial, a PCP score and D-dimer (Tina-quant) were performed. ⋯ Specificity in the highest quartile was 17.4% compared with 49.2% in the youngest (P < 0.000001). The proportion of patients with a low/moderate PCP score and a normal D-dimer decreased with age: 12% in the highest quartile (>73.8 years) versus 25% in younger patients (P = 0.00005). We therefore conclude that the combined strategy of a low/moderate PCP score with a normal D-dimer test is safe for excluding DVT in all age groups, but is less useful in the elderly.