Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

Wanli Liu,Xiang Wang,Zhicheng Gong,Lianxiang He,Jie Wei,Liqing Yue,Shuangshuang Zeng,Wenjing Zeng

doi:10.1186/s12959-021-00275-w

Abstract

BackgroundThe purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.MethodsThis was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.ResultsUnivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.ConclusionsPICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

Highlights

A peripherally inserted central venous catheter (PICC) is a tube that extends to the superior vena cava or inferior vena cava through superior limb basilic vein, median cubital vein, cephalic vein, brachial vein or external jugular vein
After adjustment of the risk factors, multivariate logistic regression analysis showed that PICC insertion increased the risk of lower extremity deep venous thrombosis (LEDVT) by 4 times (Table 2, odds ratios (ORs) = 4.268 [95 % confidence intervals (CIs): 2.501–7.282], P = 0.000)
We found that the concentration of D-dimer within seven days after PICC insertion was higher than that before PICC insertion, indicating a PICC-induced increase in D-dimer

Summary

Introduction

A peripherally inserted central venous catheter (PICC) is a tube that extends to the superior vena cava or inferior vena cava through superior limb basilic vein, median cubital vein, cephalic vein, brachial vein or external jugular vein. PICC insertion-induced endothelial injury and stasis of blood flow coupled with medication-induced hypercoagulability constitute the Virchow’s triad for thrombosis [3]. The incidence of PICC-related symptomatic upper extremity DVT (UEDVT) varies between 6 and 18 %, but it can reach 25 % in a few circumstances such as malignancies [5, 6]. The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer

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Methods

Discussion

Conclusion