Abstract:
Objectives: Cancer patients frequently require long-term central venous catheters to facilitate chemotherapy administration. However, catheter-related thrombosis represents a clinically relevant complication that may interrupt cancer treatment. The role of pharmacological thromboprophylaxis in preventing catheter-related thrombosis remains controversial due to concerns regarding bleeding risk. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of prophylactic anticoagulation for the prevention of catheter-related thrombosis in adult cancer patients with long-term central venous catheters.
Methods: A systematic search of PubMed, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov was conducted. Randomized controlled trials and observational studies evaluating prophylactic anticoagulation in adult cancer patients with long-term central venous catheters were included. The primary outcomes were catheter-related thrombosis and major bleeding. Risk of bias was assessed using RoB 2 and ROBINS-I. Meta-analyses were performed using random-effects models where feasible.
Results: Sixteen studies were included in this systematic review. Separate quantitative syntheses were performed for randomized and non-randomized studies. In the meta-analysis of three randomized controlled trials including 1022 patients, prophylactic low-molecular-weight heparin did not significantly reduce the risk of catheter-related thrombosis compared with control (RR 0.77; 95% CI 0.53-1.12). A separate analysis of two non-randomized studies including 593 patients suggested a lower reported incidence of catheter-related thrombosis with rivaroxaban (RR 0.23; 95% CI 0.11-0.48). Major bleeding outcomes were inconsistently reported across studies and could not be quantitatively synthesized.
Conclusions: Current evidence does not support routine prophylactic anticoagulation for all cancer patients with long-term central venous catheters. However, selected high-risk patients may potentially benefit from individualized thromboprophylaxis. The available evidence remains limited by heterogeneity, low certainty and inconsistent reporting of bleeding outcomes. Further adequately powered randomized trials are required.
Reference:Kania J, Zawadzki J, Kudliński B. A Systematic Review and Meta-Analysis of Prophylactic Anticoagulation for the Prevention of Catheter-Related Thrombosis in Adult Cancer Patients with Long-Term Central Venous Catheters: Current Evidence, Clinical Uncertainties and Future Directions. J Clin Med. 2026 Jul 15;15(14):5566. doi: 10.3390/jcm15145566. PMID: 42513481; PMCID: PMC13413132.