Central venous thrombosis

September 4, 2008

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The incidence of PICC- related upper extremity venous thrombosis has been reported to be anywhere between 0% and 56%. This study attempts to suggest that the use of prophylactic anticoagulation may reduce thrombotic risks in PICC’s. The authors also suggest the importance of early ultrasound if thrombosis is suspected.

Paauw, J.D., Borders, H., Ingalls, N., Boomstra, S., Lambke, S., Fedeson, B., Goldsmith, A. and Davis, A.T. (2008) The Incidence of PICC Line–Associated Thrombosis With and Without the Use of Prophylactic Anticoagulants. Journal of Parenteral and Enteral Nutrition. 32(4), p.443-447.

Abstract:

Background: Indications for peripherally inserted central catheters (PICC) for long-term venous access have grown during the last several years. There are various complications associated with PICC lines, a common one being venous thrombosis. This study’s purpose was to determine the incidence of venous thrombosis associated with PICCs with and without prophylactic anticoagulants. Methods: In this observational, prospective, cohort study, patients with PICC lines were evaluated using Doppler ultrasound for the presence of PICC-associated venous thrombosis at 5-7 days and again at 12-14 days after line placement. When present, clinical signs and symptoms of thrombosis were documented. Fifty-six patients were evaluated for the type of anticoagulation used, if any, and other clinical parameters such as smoking, ambulation, and previous surgery. The incidence of thrombus was then calculated for the entire population as well as for specific patient subgroups. Results: Patient age was 55.7 ± 2.6 (mean ± SEM) years, and BMI was 28.2 ± 1.2 (n = 56). There were 38 (67.9%) nonambulatory subjects, 15 (26.8%) smokers, 4 (7.1%) coagulopathic subjects, 2 (3.6%) patients receiving estrogen-containing medications, 25 (44.6%) who had undergone surgery within the past 6 months, and 5 (8.9%) cancer patients. There were 21/56 patients (37.5%) with thrombus. Patients who received anticoagulation had a 22.9% (8/35) incidence of thrombosis, which was significantly less (P < .05) than for those who received no anticoagulant (13/21, 61.9%). Conclusion: The use of anticoagulants for prophylaxis in patients with a PICC line was associated with a decreased rate of associated venous thrombosis.