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The Incidence of PICC Line–Associated Thrombosis With and Without the Use of Prophylactic Anticoagulants

From ¹ Spectrum Health Metabolic Nutrition Support Service, ² GRMERC/MSU Radiology Residency,³ GRMERC/MSU General Surgery Residency,⁴ Spectrum Health Interventional Radiology Service,⁵ Departments of Surgery, Michigan State University and Spectrum Health, and ⁶ GRMERC Department of Research, Grand Rapids, MI.

Address correspondence to: Alan T. Davis, PhD, Michigan State University, GRMERC, 1000 Monroe NW, Grand Rapids, MI 49503; e-mail: davisa{at}msu.edu.

Background: Indications for peripherally inserted central catheters (PICC) for long-term venous access have grown during the last several years. There are various complications associated with PICC lines, a common one being venous thrombosis. This study's purpose was to determine the incidence of venous thrombosis associated with PICCs with and without prophylactic anticoagulants. Methods: In this observational, prospective, cohort study, patients with PICC lines were evaluated using Doppler ultrasound for the presence of PICC-associated venous thrombosis at 5-7 days and again at 12-14 days after line placement. When present, clinical signs and symptoms of thrombosis were documented. Fifty-six patients were evaluated for the type of anticoagulation used, if any, and other clinical parameters such as smoking, ambulation, and previous surgery. The incidence of thrombus was then calculated for the entire population as well as for specific patient subgroups. Results: Patient age was 55.7 ± 2.6 (mean ± SEM) years, and BMI was 28.2 ± 1.2 (n = 56). There were 38 (67.9%) nonambulatory subjects, 15 (26.8%) smokers, 4 (7.1%) coagulopathic subjects, 2 (3.6%) patients receiving estrogen-containing medications, 25 (44.6%) who had undergone surgery within the past 6 months, and 5 (8.9%) cancer patients. There were 21/56 patients (37.5%) with thrombus. Patients who received anticoagulation had a 22.9% (8/35) incidence of thrombosis, which was significantly less (P < .05) than for those who received no anticoagulant (13/21, 61.9%). Conclusion: The use of anticoagulants for prophylaxis in patients with a PICC line was associated with a decreased rate of associated venous thrombosis.

Key Words: PICC • thrombosis • anticoagulant

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 4, 443-447 (2008)
DOI: 10.1177/0148607108319801


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