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Published on: February 10, 2023
Does prophylactic anticoagulation prevent PICC-related upper extremity venous thrombosis? A case-control study
James D Wilson1, Steven C Alred
1Christus Spohn Health System, Corpus Christi, Texas (Drs Wilson and Alred). James D. Wilson, MD, MS, is a faculty physician and director of the hospitalist fellowship program of the Christus Spohn Family Medicine Residency Program. He is also a medical officer in the US Army Reserve. Steven C. Alred, MD, is chief resident in the Christus Spohn Family Medicine Residency Program.
Prophylactic anticoagulation may modestly reduce the risk of upper extremity venous thrombosis associated with peripherally inserted central catheters. However, current evidence lacks statistical significance for individual preventive strategies.
Area of Science:
- Vascular Medicine
- Thrombosis Research
- Medical Device Safety
Background:
- Peripherally inserted central catheters (PICCs) are widely used, but associated with upper extremity venous thrombosis (UEVT).
- Evidence on the efficacy of prophylactic anticoagulation in preventing PICC-related UEVT (PRUEVT) remains inconsistent.
- Identifying risk factors and preventive measures for PRUEVT is crucial for patient safety.
Purpose of the Study:
- To evaluate the association between prophylactic anticoagulation and the incidence of PRUEVT.
- To assess the risk of PRUEVT in patients not receiving anticoagulant or antiplatelet therapy.
Main Methods:
- Retrospective review of 3 years of PRUEVT cases at a Texas facility.
- Case-control study matching PRUEVT cases with two controls based on risk factors.
- Statistical analysis including odds ratios and confidence intervals to determine risk association.
Main Results:
- Patients not on any anticoagulant or antiplatelet agent had a modestly increased risk of PRUEVT (OR 1.93, P=.036).
- All evaluated thrombosis prevention strategies demonstrated a trend toward a protective effect.
- No single preventive approach reached statistical significance individually.
Conclusions:
- While not statistically significant individually, prophylactic anticoagulation and antiplatelet agents may offer a protective trend against PRUEVT.
- Further research with larger sample sizes is warranted to confirm the efficacy of specific prophylactic strategies for PRUEVT.
