Post-thrombotic Syndrome & Predictors of Recurrence in Catheter-related Thrombosis

Not Applicable

Completed

Conditions: Venous Thrombosis
Neoplasms

Interventions: Drug: Heparin, Low-Molecular-Weight, or direct oral anticoagulants

Registration Number: NCT01999179

Lead Sponsor: Medical College of Wisconsin

Brief Summary: The goal of the pilot study is to determine if a multicenter prospective cohort study of cancer patients with blood clots associated with catheters is feasible. Cancer patients with catheter-related thrombosis treated with one month of anticoagulation will be evaluated for for post-thrombotic syndrome. Laboratory biomarkers will be evaluated as predictors of recurrent thrombosis.

Detailed Description: Participants may be referred for screening at Medical College of Wisconsin (MCW) in two possible mechanisms: participant contact study staff from information on Clinical Trials Science Institute (CTSI) FACT website or referral from treating Hematologist or Oncologist. At MCW, an EPIC report will be generated to identify people with catheter related thrombosis (CRT). The treating provider would then be contacted to determine if referral to the study was appropriate. Subjects at Ohio State University (OSU) will be referred from the treating Hematologist or Oncologist. A report generated in Epic will be used to identify people with CRT. The treating provider would then be contacted to determine if referral to the study was appropriate. Participants will be given printed information about the study or verbal explanation using the informational flyer. Verbal consent will be obtained to be screened for participation and contacted by study personnel. Screening will be completed by BloodCenter of Wisconsin (BCW) nurse coordinator. We aim to consent and enroll patients after diagnosis of catheter-related thrombosis and prior to catheter removal. Consent and enrollment (Visit 1) must occur prior to discontinuation of anticoagulation. Participants will be treated with either enoxaparin for one month following catheter removal, or direct oral anticoagulant treatment (apixaban, rivaroxaban, dabigatran, or edoxaban). Anticoagulation will be continued for 1 month after catheter removal. The minimum duration of anticoagulation will be one month and maximum duration is 7 months. The cost of enoxaparin will be the responsibility of the participant as use of the medication is part of routine care. Subjects will be contacted by telephone prior to discontinuation of anticoagulation to review study protocol, assess for bleeding, and see if any continuation rules apply and arrange for research visit 2 in the following 1-2 weeks. Visits 3 and 4 will occur 3 and 6 months after catheter removal, respectively. At visits 3 \& 4, Medical history, cancer history, and medications will be updated. At each visit, participants will be assessed for post-thrombotic syndrome using the modified Villalta scale and functional limitation using the DASH questionnaire. At MCW, surveys will be administered by the research coordinator and/or Translational Research Unit (TRU) staff and physical examination will be completed by BCW nurse coordinator. At OSU, surveys will be administered by research coordinators and physical examination will be administered by research nurse coordinator. Laboratory samples will be obtained for MCW participants only.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 27

Inclusion Criteria

Upper extremity venous thrombosis associated with an indwelling catheter documented by ultrasound, CT or venography
Current hematologic or solid tumor malignancy undergoing chemotherapy, surgery, radiation or hormonal therapy for malignancy.
>18 years of age
Platelet count >50,000
Creatinine clearance >30 ml/min
Ability to provide informed consent

Exclusion Criteria

Underlying medical condition or chemotherapy requiring long-term anticoagulation
Known underlying higher risk thrombophilias including antiphospholipid antibody syndrome, antithrombin, protein C or protein S deficiencies, or homozygosity or compound heterozygosity for prothrombin G20210A or Factor V R506Q mutations.
Inability to remove venous catheter
Anticipated replacement of central venous catheter within 3 months
Major bleeding or clinically relevant non-major bleeding in the preceding 60 days
Participation in another clinical trial that requires anticoagulation
Use of anticoagulant other than low-molecular weight heparin
Treatment with thrombolysis
Catheter removal >1 month prior to enrollment

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
low-molecular-weight heparin or direct oral anticoagulant	Heparin, Low-Molecular-Weight, or direct oral anticoagulants	Enoxaparin 1 mg/kg subcutaneously every 12 hours for one month following catheter removal or alternate enoxaparin dose or interval based on anti-factor Xa testing that was obtained by clinical team. Apixaban, rivaroxaban, dabigatran, or edoxaban at standard dosing per FDA package insert for direct oral anticoagulants.

Primary Outcome Measures

Name	Time	Method
PTS Assessment Completion	1 year	Percentage of participants who completed post-thrombotic syndrome assessments

Secondary Outcome Measures

Name	Time	Method
Biomarker Sample Collection	1 year	Number of participants that completed sample collection for biomarker analysis to predict recurrent venous thrombosis

Trial Locations

Locations (3): The Ohio State University
🇺🇸
Columbus, Ohio, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
University of Minnesota
🇺🇸
Minneapolis, Minnesota, United States