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Riesgo de tromboembolismo venoso asociado con catéteres centrales insertados periféricamente: una revisión
Vineet Chopra1, Sarah Anand, Andy Hickner
1Department of Internal Medicine, Division of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA. vineetc@umich.edu
Lancet (London, England)
|May 24, 2013
Resumen
Los catéteres centrales insertados perifericamente (PICC) aumentan el riesgo de trombosis venosa profunda en comparación con otros catéteres venosos centrales (CVC). Este riesgo es mayor en pacientes en estado crítico y aquellos con cáncer, lo que requiere una cuidadosa consideración de los beneficios frente a los riesgos de trombosis.
Área de la Ciencia:
- Dispositivos de acceso vascular Dispositivos de acceso vascular
- Investigación de la trombosis.
- La seguridad de los dispositivos médicos.
Sus antecedentes:
- Los catéteres centrales insertados perifericamente (PICC) están relacionados con una mayor incidencia de tromboembolismo venoso.
- El riesgo comparativo de tromboembolismo venoso entre los PICC y otros catéteres venosos centrales (CVC) sigue sin estar claro.
Objetivo del estudio:
- Realizar una revisión sistemática y un metanálisis comparando el riesgo de tromboembolismo venoso asociado con los PICC frente a otros CVC.
Principales métodos:
- Una búsqueda exhaustiva en varias bases de datos (Medline, Embase, Scopus, etc.) para hacer una búsqueda completa. y se realizaron revisiones manuales.
- Se incluyeron estudios en humanos de pacientes adultos sometidos a inserción de PICC, evaluados utilizando la escala Newcastle-Ottawa.
- Se usó el metaanálisis de la frecuencia agrupada y los efectos aleatorios para calcular las proporciones de probabilidades de tromboembolismo venoso.
Principales resultados:
- 64 estudios con 29,503 pacientes cumplieron con los criterios de elegibilidad.
- El uso de PICC se asoció con un mayor riesgo de trombosis venosa profunda (OR 2.55, p<0.0001) en comparación con los CVC.
- El número necesario para causar daño fue de 26, con mayores riesgos observados en pacientes en estado crítico y en pacientes con cáncer.
Conclusiones:
- Los PICC están asociados con un riesgo significativamente mayor de trombosis venosa profunda que los CVC.
- Este aumento del riesgo es particularmente pronunciado en pacientes en estado crítico y aquellos con tumores malignos.
- Las decisiones clínicas con respecto a la inserción de PICC deben equilibrar los beneficios del dispositivo con el mayor riesgo de trombosis.
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