Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta‐Analysis

1Ann Arbor VA Medical Center, Ann Arbor, MI
2University of Michigan, Ann Arbor, MI
3Ann Arbor VA Medical Center, Ann Arbor, MI
4University of Michigan, Ann Arbor, MI
5Ann Arbor VA Medical Center, Ann Arbor, MI
6University of Michigan, Ann Arbor, MI

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 91

Background:

Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism (VTE). However, the precise incidence and magnitude of this risk relative to other central venous catheters (CVCs) is unknown. We performed a systematic review and meta‐analysis of the risk of VTE associated with PICCs.

Methods:

Multiple databases including MEDLINE, Embase, BIOSIS, Cochrane CENTRAL Register of Controlled Trials, Conference Papers Index, and Scopus were searched. Additional studies were identified through hand searches of bibliographies, and study authors were contacted for unpublished data. In studies without a comparison arm, the pooled frequency of VTE was calculated for patients receiving PICCs. In studies that compared PICCs with other CVCs, summary odds ratios (ORs) were calculated using random‐effects meta‐analysis for the outcome of VTE.

Results:

Of 533 citations identified, 63 studies (11 studies with a comparison arm, 52 without a comparison arm) involving 28,931 patients met eligibility criteria. In the noncomparison studies, the weighted incidence of PICC‐related DVT was greatest in those who were critically ill (13.98; 95% CI, 7.50–20.45) and in those with cancer (6.43%; 95% CI, 4.41–8.46). Pooled meta‐analysis of 10 studies that compared the risk of PICC‐related DVT with CVCs showed that PICCs were associated with an increased risk of DVT (OR, 2.33; 95% CI, 1.38–3.94) but not PE (0 events). Using the baseline rate of 2.6% for PICC‐related DVT and a pooled OR of 2.33, the number needed to harm (NNH) was 30.

Conclusions:

Compared with CVCs, PICCs are associated with greater risk of DVT, especially in those who are critically ill or suffer from malignancy. The decision to insert PICCs should be guided by weighing the risk of thrombosis against the benefit provided by these devices, especially in high‐risk populations.

Forest plot showing risk of PICC‐associated DVT versus central venous catheters.

Risk of PICC‐related DVT by specific patient populations,

To cite this abstract:

Chopra V, Anand S, Hickner A, Rogers M, Saint S, Flanders S. Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta‐Analysis. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 91. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/risk-of-venous-thromboembolism-associated-with-peripherally-inserted-central-catheters-a-systematic-review-and-metaanalysis/. Accessed July 23, 2019.

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