Jones Daniel, Wismayer Kurt, Bozas George, Palmer June, Elliott Mandi, Maraveyas Anthony
Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull and East Yorkshire Hospitals Trust, Hull, UK.
Hull York Medical School, York, UK.
Thromb J. 2017 Sep 19;15:25. doi: 10.1186/s12959-017-0148-y. eCollection 2017.
Deep vein thrombosis (DVT) is a common complication of peripherally inserted central catheters (PICCs). PICCs are increasingly utilised in the management of cancer patients, a group which carries both additional risks for vascular thromboembolism as well as for complex morbidity. We analysed a cohort of cancer patients subjected to PICC insertion in a single cancer centre for the incidence of all-type vascular thromboembolism (VTE) and investigated relative risk factors.
In this clinical audit, the records of patients referred for PICC insertion in our centre in the period between 1/1/2011 and 1/4/2014 were retrospectively reviewed. The primary outcomes investigated were a) PICC-related deep vein thrombosis (PRDVT) and b) distant VTE (lower limb DVT and pulmonary embolism). 4Fr single lumen PICCs were placed in all patients. The Kaplan Meier method was used to study time from PICC insertion to PRDVT/VTE. Survival curves were compared using the log rank method. Logistic and Cox regression analyses were used to assess local, distant and combined endpoints.
Four hundred ninety patients were included in the analysis of which 27 (5.5%) developed a PRDVT. Statistically significant risk factors for developing PRDVT in multivariate analysis included more than one attempt for insertion (OR 2.61, 95%CI: 1.12-6.05) and the use of fluoropyrimidine containing chemotherapy (OR 4.27, 95%CI 1.3-14.07). Twenty-six patients developed a distant VTE. Male gender was the only significant risk factor for distant VTE. When all-type VTE were considered together fluoropyrimidine containing chemotherapy (OR 4.54, 95% CI 1.63-12.61), male gender (OR 2.03, 95% CI 1.04-3.93) and white cell count (OR 1.12, 95% CI 1.00-1.26) were statistically significant as risk factors in this analysis.
This is a large study of VTE following PICC insertion in cancer patients which also looks at the rate of distant VTE. The observed PRDVT incidence is comparable with available literature. Fluoropyrimidine containing chemotherapy and more than one attempt for PICC insertion were independent predictors of PICC-associated VTE whilst the former remained an independent predictor of all-type VTE. Anticoagulation did not prevent thrombotic events in this cohort.
深静脉血栓形成（DVT）是外周静脉穿刺中心静脉导管（PICC）常见的并发症。PICC在癌症患者的治疗中应用越来越广泛，而这一群体发生血管血栓栓塞及复杂发病的风险更高。我们分析了在单一癌症中心接受PICC置管的一组癌症患者中所有类型血管血栓栓塞（VTE）的发生率，并调查了相关危险因素。
在本次临床审计中，回顾性分析了2011年1月1日至2014年4月1日期间在我们中心接受PICC置管患者的记录。主要研究结局为：a）PICC相关深静脉血栓形成（PRDVT）和b）远处VTE（下肢DVT和肺栓塞）。所有患者均置入4Fr单腔PICC。采用Kaplan-Meier方法研究从PICC置管到PRDVT/VTE的时间。使用对数秩检验比较生存曲线。采用逻辑回归和Cox回归分析评估局部、远处及综合终点。
490例患者纳入分析，其中27例（5.5%）发生PRDVT。多因素分析中，PRDVT发生的统计学显著危险因素包括多次置管尝试（比值比[OR]2.61，95%置信区间[CI]：1.12 - 6.05）和使用含氟嘧啶的化疗（OR 4.27，95%CI 1.3 - 14.07）。26例患者发生远处VTE。男性是远处VTE唯一的显著危险因素。当将所有类型VTE合并考虑时，含氟嘧啶的化疗（OR 4.54，95%CI 1.63 - 12.61）、男性（OR 2.03，95%CI 1.04 - 3.93）和白细胞计数（OR 1.12，95%CI 1.00 - 1.26）在本分析中作为危险因素具有统计学意义。
这是一项关于癌症患者PICC置管后VTE的大型研究，同时也观察了远处VTE的发生率。观察到的PRDVT发生率与现有文献相当。含氟嘧啶的化疗和多次PICC置管尝试是PICC相关VTE的独立预测因素，而前者仍是所有类型VTE的独立预测因素。在该队列中，抗凝未能预防血栓形成事件。
