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Clinical and Applied Thrombosis/Hemostasis
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Relationship Between Activated Protein C Resistance and Central Venous Device-Related Complications

Yi-Kong Keung, M.B.,B.S.

Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas

Everardo Cobos, M.D.

Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas

Annabel Barber, M.D.

Department of Surgery; Texas Tech University Health Sciences Center, Lubbock, Texas

Cathy Ronaghan, M.D.

Department of Surgery; Texas Tech University Health Sciences Center, Lubbock, Texas

Robert Whitehead, M.D.

Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas

Melody Staton, R.N., B.S.N., O.C.N.

Southwest Cancer Center

Mary Gilbert, M.T. A.S.C.P., S.H.

Clinical Laboratory, University. Medical Center, Lubbock, Texas, U.S.A.

David Morgan, M.D.

Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas

We studied the relationship between activated protein C (APC) resistance and the central venous devices (CVD)-related complications in 61 cancer patients (44 females `and 17 males, median age 50 years, 71 CVD) from November 1994 to November 1995. Two patients (3.3%) had APC resistance, i.e., APC ratio < 2. Twelve episodes of bactercmia, 8 site infections, 31 cases of CVD dysfunction requiring urokinase (UK), and 3 CVD-retated thromboses were noted. With Cox's proportional hazard models, low APC ratios and high d-dimer levels were significantly associated with CVD-related bacteremia (p = 0.0207 and 0.0210). Such an association was not observed with site infection and CVD dysfunction. The incidence of thrombosis was too low to be analyzed. However, one patient with APC resistance developed subclavian vein thrombosis, leading to eventual removal of the catheter. The prevalence of APC resistance in cancer patients and its association with bacteremia are discussed. Key Words : Activated protein C resistance—Central venous catheters—Bacteremia— Catheter site infection—Thrombosis.

Clinical and Applied Thrombosis/Hemostasis, Vol. 3, No. 2, 133-136 (1997)
DOI: 10.1177/107602969700300212
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