A study of more than 70,000 patients suggests the use of peripherally inserted central catheters (PICCs) is not only associated with upper-extremity deep vein thrombosis (DVT).
It’s linked to lower-extremity DVT as well. However, PICC use was not associated with pulmonary embolism (PE).
Vineet Chopra, MD, of the University of Michigan in Ann Arbor, and his colleagues reported these findings in The American Journal of Medicine.
“Our study confirmed that PICCs are strongly associated with DVT in upper limbs,” Dr Chopra said. “However, what is novel and noteworthy in this study is that the presence of a PICC was also associated with an increased risk of lower-extremity DVT. Prior studies had not assessed whether PICCs are independently associated with an increase in the risk of subsequent lower-extremity DVT.”
Dr Chopra and his colleagues analyzed data from 76,242 patients hospitalized at 48 Michigan hospitals.
The team reviewed PICC placement, existing medical conditions, risk factors for venous thromboembolism (VTE), and thrombotic events occurring within 90 days of hospital admission.
A total of 3790 patients received a PICC during hospitalization. And there were 876 VTEs, including 208 upper-extremity DVTs, 372 lower-extremity DVTs, and 296 PEs.
After adjusting for risk factors other than PICC use, the researchers found that PICCs were independently associated with all-cause VTE, upper-extremity DVT, and lower-extremity DVT, but not PE. The hazard ratios were 3.16, 10.49, 1.48, and 1.34, respectively.
The team also found that VTE prophylaxis did not reduce the risk of DVT.
“Taken together, these findings suggest that the thrombotic burden associated with peripherally inserted central catheters may not be restricted to the extremity where the device resides or easily attenuated after insertion,” Dr Chopra said.
He and his colleagues therefore concluded that clinicians should weigh the risks and benefits of PICC use and consider using alternative devices in patients at high risk of DVT. And clinicians should not focus only on the extremity where a PICC resides but the composite risk of VTE among patients who receive a PICC.
