127 - Risk Factors for Chest Port-Related Thrombotic Complications in Lung Cancer Population

Purpose: Venous thromboembolism is prevalent in lung cancer population, and the prevalence has been reported to be higher compared to other solid malignancies {1}. Patients with advanced lung cancer often require a chest port (port) for administration of chemotherapy. To establish preventative measures, we attempted to elucidate risk factors or subgroups at risk for port-related thrombotic complications.

Materials and Methods: Among 4,473 ports placed in 4,473 patients between 2013 and 2024, 968 ports were placed in 968 patients with lung cancer (Female/Male: 465/459, median age: 65 years old). Thrombotic complications including catheter-related venous thrombosis and fibrin sheath requiring port removal were identified through chart and imaging review. Patient characteristics (age, gender, BMI, diabetes, steroid/anticoagulant/ antiplatelet agent use, leukopenia /neutropenia/ thrombocytopenia/ hypoalbuminemia, coagulopathy (INR >1.5) at the time of port placement, clinical history) and port characteristics (right vs. left, lumen number, catheter tip location, and prior port removal) were recorded. Multivariate proportional subdistribution hazards regression (PSHREG) was used to identify risk factors for port-related thrombotic complications.

Results: The cumulative follow-up period of all 968 patients was 487,540 catheter-days (range: 1-3,737 catheter-days; median: 313 catheter-days). A total of 41/968 (4.69%) patients developed port-related thrombotic complications (0.08 events/1000 catheter-days). The median time to thrombotic complications was 227 catheter-days (range: 1-3,437 catheter-days). Univariate analysis indicated that anticoagulant use at anytime (P = 0.02) were risk factors for thrombotic complications. Antiplatelet use at any time (P = 0.02) was a protective factor for thrombotic complications. Multivariate analysis further demonstrated that anticoagulant use (HR 2.29, 95% CI 1.22-4.27, P = 0.01) were independent risk factors for chest port thrombotic complications; while antiplatelet use at any time (HR 0.37, 95% CI 0.17-0.80, P = 0.01) was an independent protective factor.

Conclusion: Anticoagulant use was an independent risk factor for chest port thrombotic complications, while antiplatelet use at any time was a protective factor in lung cancer population. Monitoring and maintaining of therapeutic INR in patients with anticoagulant(s) may prevent port-related thrombotic complications.