PICC associated venous thromboembolism in upper and lower extremities

0

Reference:

Greene, M.T., Flanders, S.A., Woller, S.C., Bernstein, S.J. and Chopra, V. (2015) The Association Between Peripherally Inserted Central Catheter Use and Venous Thromboembolism in Upper and Lower Extremities. The American Journal of Medicine. May 1st. [epub ahead of print].

Abstract:

BACKGROUND: Peripherally inserted central catheters (PICCs) are associated with upper extremity-deep vein thrombosis. Whether they are also associated with lower extremity-deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep veins of the arm, leg and chest following PICC placement.

METHODS: We conducted a multicenter, retrospective, cohort study of 76,242 hospitalized medical patients from 48-Michigan hospitals. PICC presence, comorbidities, venous thrombosis risk factors, and thrombotic events within 90-days from hospital admission were ascertained by phone and record review. Cox proportional hazards models were fit to examine the association between PICC placement and 90-day hazard of upper- and lower-extremity deep vein thrombosis or pulmonary embolism, adjusting for patient-level characteristics and natural clustering within hospitals.

RESULTS: 3,790 patients received a PICC during hospitalization. From hospital admission to 90-days, 876 thromboembolic events (208 upper-extremity, 372 lower-extremity deep vein thromboses and 296 pulmonary emboli) were identified. Following risk-adjustment, PICC use was independently associated with all-cause venous thromboembolism (HR=3.16, 95% confidence interval [CI]=2.59-3.85), upper-extremity deep vein thrombosis (HR=10.49, 95%CI 7.79-14.11) and lower-extremity deep vein thrombosis (HR=1.48, 95%CI=1.02-2.15). PICC use was not associated with pulmonary embolism (HR=1.34, 95%CI=0.86-2.06). Results were robust to sensitivity analyses incorporating receipt of pharmacologic prophylaxis during hospitalization.

CONCLUSIONS: PICC use is associated with upper- and lower-extremity deep vein thrombosis. Weighing the thrombotic risks conferred by PICCs against clinical benefits appears necessary.

Thank you to our partners for supporting IVTEAM

Share.

Comments are closed.

Free Email Updates
Join 5.5K IVTEAM members. Subscribe now and be the first to receive all the latest free updates from IVTEAM!
100% Privacy. We don't spam.