Original Article

Peripherally Inserted Central Venous Catheter-associated Thrombosis: Retrospective Analysis of Clinical Risk Factors in Adult Patients

Authors: Melissa M. King, MD, Mark S. Rasnake, MD, Rechell G. Rodriguez, MD, FACP, Nancy J. Riley, RN, Jason A. Stamm, MD

Abstract

Background: Peripherally inserted central catheters (PICC) are common venous access devices. Clinical conditions and therapies that increase the risk of PICC-associated thrombosis have not been studied.


Methods: We performed a retrospective case-control analysis of all adult patients who underwent placement of a PICC at our hospital over a three-year period (n = 1296). Clinical variables examined were indication for PICC placement, active cancer treatment, history of DVT, diabetes mellitus, and use of prophylactic anticoagulation.


Results: The overall incidence of PICC-associated DVT was 2% (n = 27). Active cancer therapy was significantly associated with PICC-associated DVT (OR 3.5, 95% CI 1.3-9.8). The use of prophylactic anticoagulation did not reduce this risk.


Conclusions: Patients who suffered a PICC-associated DVT were more likely to be undergoing treatment for cancer. This risk was not lowered by the use of prophylactic anticoagulation. These results suggest a need for prospective studies on effective anticoagulation for patients at high risk for PICC-associated DVT.

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References

1. Smith JR, Friedell ML, Cheatham ML, et al. Peripherally inserted central catheters revisited. Am J Surg 1998;176:208–211.
 
2. Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:1309–1314.
 
3. Gonsalves CF, Eschelman DJ, Sullivan KL, et al. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 2003;26:123–127.
 
4. Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003;21:3665–3675.
 
5. Joffe HV, Kucher N, Tapson VF, et al. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation 2004;110:1605–1611.
 
6. Grove JR, Pevec WC. Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:837–840.
 
7. Ng PK, Ault MJ, Ellrodt AG, et al. Peripherally inserted central catheters in general medicine. Mayo Clin Proc 1997;72:225–233.
 
8. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1–7.
 
9. Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000;160:761–768.
 
10. Prandoni P, Polistena P, Bernardi E, et al. Upper-extremity deep vein thrombosis: risk factors, diagnosis, and complications. Arch Intern Med 1997;157:57–62.
 
11. Fonseca V, Desouza C, Asnani S, et al. Nontraditional risk factors for cardiovascular disease in diabetes. Endocr Rev 2004;25:153–175.
 
12. Shah MK, Burke DT, Shah SH. Upper-extremity deep vein thrombosis. South Med J 2003;96:669–672.
 
13. Luciani A, Clement O, Halimi P, et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001;220:655–660.
 
14. Bern MM, Lokich JJ, Wallach SR, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters: a randomized prospective trial. Ann Intern Med 1990;112:423–428.
 
15. Boraks P, Seale J, Price J, et al. Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies. Br J Haematol 1998;101:483–486.
 
16. Heaton DC, Han DY, Inder A. Minidose (1 mg) warfarin as prophylaxis for central vein catheter thrombosis. Intern Med J 2002;32:84–88.
 
17. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):338S–400S.
 
18. Kuriakose P, Colon-Otero G, Paz-Fumagalli R. Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol 2002;13:179–184.
 
19. Shetty PC, Mody MK, Kastan DJ, et al. Outcome of 350 implanted chest ports placed by interventional radiologists. J Vasc Interv Radiol 1997;8:991–995.
 
20. Bodner LJ, Nosher JL, Patel KM, et al. Peripheral venous access ports: outcomes analysis in 109 patients. Cardiovasc Intervent Radiol 2000;23:187–193.
 
21. Baarslag HJ, van Beek EJ, Koopman MM, et al. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med 2002;136:865–872.