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Larger-gauge PICCs, VTE history increase PICC-DVT risk


 

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Risk factors of upper-extremity deep vein thrombosis associated with peripherally inserted central catheters include a history of venous thromboembolism and a larger-gauge catheter, according to Dr. Vineet Chopra and his associates at the University of Michigan Health System, Ann Arbor.

Compared to 4-Fr gauge PICCs, 5-Fr and 6-Fr PICCs significantly increased PICC-DVT risk, with odds ratios of 2.7 and 7.4, respectively. The OR for patients with a prior history of VTE was 1.7. While any surgery with a PICC in place increased risk, the OR was higher in surgery lasting less than 2 hours (2.75 vs. 2.17). PICCs inserted into the brachial or cephalic vein also increased PICC-DVT risk, compared with the basilic vein, with ORs of 6.8 and 5.8, respectively.

Patients who received both aspirin and statins were at a significantly lower risk of PICC-DVT than those who received only one drug or neither, with an OR of 0.31 for those who got both, compared with 0.77 for aspirin and 0.61 for statins. Pharmacologic VTE prophylaxis also benefited patients with an OR of DVT at 0.72.

“Given the existence of other supportive data regarding the influence of VTE prophylaxis on PICC-DVT and a potentially protective role of statins on thrombosis, further controlled studies of VTE prophylaxis, antiplatelet treatment, and statins to prevent PICC-DVT appear warranted,” the investigators recommended.

Find the full study in Thrombosis Research (doi:10.1016/j.thromres.2015.02.0120).

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