Placing Central Lines and DVTs?


Does the simple act of inserting a central venous catheter induce a hypercoagulable state in patients?

Research presented at the Eastern Association for the Surgery of Trauma shows that central venous line insertion significantly decreases clotting time and initial clot formation time and accelerates fibrin cross-linking in both healthy swine and critically ill patients.

Courtesy Wikimedia Commons/Jsonp/Creative Commons License

The findings indicate that CV catheters induce a systemic hypercoagulable state, probably because of the endothelial injury, which may explain the increased risk for venous thromboembolism associated with central venous lines, said lead author Dr. Mark Ryan, with the University of Miami School of Medicine.

The prospective, observational trial involved eight patients whose blood was drawn from an indwelling peripheral arterial catheter before and 60 minutes after central venous line catheterization and analyzed with thromboelastography (TEG). Ten swine consented to having their blood drawn as well.

The group previously reported that placing a pulmonary artery catheter in critically ill patients and healthy swine significantly decreases the time to initial fibrin formation, thereby inducing a hypercoagulable state.

Photo Patrice Wendling/Elsevier Global Medical News

Dr. Mark Ryan

As in the current study, however, no changes were observed in conventional coagulation parameters, raising questions as to why standard coagulation tests fail to correlate with TEG and whether the prothrombotic state identified by TEG truly indicates an increased risk for deep vein thrombosis, Dr. Ryan said.

Finally, as has been suggested by other investigators, pigs may simply have a very different hypercoagulable state than humans do. I selfishly hope so.

–Patrice Wendling

Recommended Reading

FDA Sends User Fee Recommendations to Congress
MDedge Cardiology
Diet May Reverse 30 Years of Blood Pressure Aging
MDedge Cardiology
First U.S. Fibromuscular Dysplasia Registry Yields New Clues
MDedge Cardiology
FDA Turns Down Novel Antidiabetes Drug
MDedge Cardiology
Medical Data a Start, Not the Answer
MDedge Cardiology
Do Trauma Patients Need An Aspirin?
MDedge Cardiology
Excitement builds for renal denervation in hypertension
MDedge Cardiology
Aortic Regurgitation After TAVR Poses Threat
MDedge Cardiology
Odds of Referral Nearly Doubled Over Decade
MDedge Cardiology
PCI Trial Halted After FFR's Benefit Shown
MDedge Cardiology