Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: a systematic review and meta-analysis.

BACKGROUND Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAPs associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. METHODS Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. RESULTS In total, 80 studies (11 with a comparison group and 69 without) including 39148 patients were retrieved. In the non-comparison studies, the overall symptomatic VTE incidence was 2.76% (95% CI 2.24-3.28%), and 0.08 (95% CI, 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95%CI 2.94-4.76%). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (PICCs) (OR= 0.20, 95% CI 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. CONCLUSIONS Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.