Efficacy and safety evaluation of thromboprophylaxis strategies for central venous catheter-related thrombosis in cancer patients: a bayesian network meta-analysis and bibliometric analysis.

2026-04-14
Frontiers in pharmacology 17
- Mingyu Meng
- Qimeng Xu
- Shiran Qin
- Xiaoyu Chen
- Congzhi Qin
- Muling Shen
- Dandan Xu
- Shiyao Pang
- Jingsi Zhong
- Yuan Fan
- Yongxia Xu
- Qin Yi
- Henghai Su
- Jian Qin

PubMed: 42057843
DOI: 10.3389/fphar.2026.1786836

Study Design

Type: Systematic Review
Sample size: n = 680
Population: patients with cancer who have central venous catheters
Methods: bibliometric analysis of English-language publications indexed in the Web of Science (2000-2025); Bayesian network meta-analysis of clinical studies on prophylactic anticoagulation for CRT in cancer patients
Duration: 2000-2025

Background

Catheter-related thrombosis (CRT) is a common complication following central venous catheter (CVC) placement in patients with cancer, increasing mortality and adverse outcomes. However, robust evidence on optimal prophylactic anticoagulation strategies remains limited.

Methods

A bibliometric analysis was performed on English-language publications on CVC-associated thrombosis prevention in cancer patients indexed in the Web of Science (2000-2025). Descriptive analyses were conducted using the Bibliometrix package in R, with visualizations generated by VOSviewer and CiteSpace. For the network meta-analysis, clinical studies on prophylactic anticoagulation for CRT in cancer patients were systematically searched (up to 28 May 2025), and a Bayesian network meta-analysis was performed using R packages netmeta and gemtc.

Results

A total of 680 publications from 52 countries were identified. The United States led in both publication output and citations, and research focus shifted from warfarin and low-molecular-weight heparin (LMWH) toward direct oral anticoagulants (DOACs). Nineteen clinical studies were included in the network meta-analysis. Compared with no prophylaxis, apixaban reduced CRT incidence (OR 0.31, 95% CI 0.17-0.54), and vitamin K antagonists (VKA), rivaroxaban, and LMWH also showed significant reductions. VKA was associated with a higher bleeding risk than apixaban (OR 2.29, 95% CI 1.08-4.98) and no prophylaxis. No significant differences were found for major bleeding, all-cause mortality, or adverse events among other treatments.

Conclusion

Apixaban, VKA, rivaroxaban, and LMWH effectively prevent CRT, while VKA is associated with an increased bleeding risk. These findings support the favorable effect of DOACs on CRT prevention. Long-term safety data from large-scale, multicenter trials are still needed.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD420251218825.