Peripheral catheters raise blood-clot risk in cancer

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Compared with other central venous catheters (CVCs), peripherally inserted central catheters (PICCs) more than doubled the risk of venous thromboembolism, a meta-analysis of studies recently revealed.

PICCs have become the preferred device for long-term intravenous delivery of such fluids as chemotherapy drugs and nutrition, according to a statement from the University of Michigan Health System (UMHS) in Ann Arbor, Michigan. These catheters carry lower risks of infection than do other CVCs, are convenient to place at the bedside, and can remain in place for long periods. Usually inserted in the arm as opposed to the neck, chest, or groin, PICCs are less likely to damage nerves or arteries.

Both types of catheters are associated with an increased risk of venous thromboembolism, but the size of the risk with PICCs relative to that with other CVCs had been unknown. Now, a team led by UMHS hospitalist and Assistant Professor of Internal Medicine Vineet Chopra, MD, has discovered that PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in critically ill persons or in those with a malignancy.

After analyzing the results of 64 studies involving a total of 29,503 adults who had undergone insertion of a PICC or another CVC, Chopra's group found that the weighted frequency of PICC-related deep vein thrombosis was highest in persons who were critically ill (13.91%) and in those with cancer (6.67%). One group of 11 studies comparing the PICC-related risk of deep vein thrombosis with CVC-related risk indicated that PICCs were more than twice as likely to cause deep vein thrombosis (odds ratio [OR] 2.55), but not pulmonary embolism (no such events were recorded).

Chopra and colleagues calculated that with the baseline PICC-related deep vein thrombosis rate of 2.7% and pooled OR of 2.55, the number needed to harm relative to CVCs was 26. 

In the UMHS statement, Chopra acknowledged that PICCs could still be the best choice for some patients, but that the risk of blood clots may be higher than previously recognized. He and his coauthors concluded in The Lancet that the decision to insert PICCs should be guided by weighing the risk of thrombosis against the benefit provided by these devices.
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