Clinical Analysis Of Peripherally Inserted Central Venous Catheter-Related Thrombosis Events In Patients With Malignant Tumors

OBJECTIVE:PICC-related thrombosis(PRT)is a serious complication that can lead to interruptions in chemotherapy and other supportive care,as well as increased hospital stay and costs.The purpose of this study was to evaluate the incidence and risk factors of symptomatic PRT in patients with malignant tumors receiving chemotherapy by retrospectively analyzing the clinical data.PATIENTS AND METHODS:A retrospective study of 938 PICC patients from Northern Jiangsu People's Hospital affiliated to Yangzhou University between November 2014 and July 2017 was performed.Symptomatic PRT events were confirmed by color Doppler ultrasonography or computed tomography pulmonary angiography(CTPA)in the presence of clinical symptoms.The clinical data of patients were extracted from the electronic medical record system,including patients' demographic characteristics and medical history:age,gender,Body Mass Index(BMI),history of chemotherapy,smoking,history of thrombosis,history of surgery,history of inserting a PICC;pathological diagnosis;laboratory investigations:D dimer concentration,fibrinogen(FIB)concentration and platelet(PLT)count;factors linked to catheter:insert vein,insert arm and indwelling time;medications:chemotherapy type,blood transfusion,parenteral nutrition,antiplatelet drugs,radiotherapy and lifting upper extremity due to radiotherapy;comorbidities:bacteremia,puncture site infection,hypertension,diabetes,cerebrovascular disease,heart disease,COPD and kidney disease.Indwelling time was calculated from PICC insertion to removal.And the time from PICC insertion to the identification of symptomatic PRT was also collected in our study.Univariate and multivariate logistic regression analysis was used to determine the risk factors for PRT.RESULTS:Of the 938 patients who were followed up for more than 120,000 patient days,the median follow-up time was 114 days,63 patients(6.7%,0.51 per 1000 catheter days)had symptomatic PRT.And 61 patients were diagnosed with upper extremity venous thrombosis(UEVT),of which 18 were isolated superficial venous thrombosis(SVT),19 were isolated deep vein thrombosis(DVT)and 24 were extensive venous thrombosis(EVT).Two patients were diagnosed with pulmonary embolism(PE),and two patients were diagnosed as UEVT with PE.The symptomatic SVT occurred in 42 of 938 patients with malignant tumors(4.5%),which accounted for 68.9%of all UEVT events.The median time to PRT was 21 days,and the median time to catheter removal in the PRT group was 66 days as compared with 117 days in the no-PRT group.Univariate logistic regression analysis showed that factors such as the age,gender,BMI,hypertension with antihypertension treatment,history of chemotherapy,type of cancer,chemotherapy regimens(Cyclophosphamide,Fluorouracil,Paclitaxel,Platinum and Anthracyclines),bacteremia,blood transfusion,total parenteral nutrition,radiotherapy and frequent lifting of upper extremity due to radiotherapy were significant predictive factors of PRT.In the multivariate logistic regression analysis,present study showed that age>60 years old(OR 2.142,95%CI:1.118-4.103),and chemotherapy regimen containing fluorouracil(OR 2.429,95%CI:1.013-5.825)were independent risk factors of PRT.Hypertension with medication was a protective factor for PRT(OR 0.306,95%CI:0.113-0.828).Among the 28 patients who didn't remove their PICCs immediately after PRT was diagnosed,patients with SVT,DVT and EVT had similar success rates of retaining catheters in situ after anticoagulant therapy(SVT:83.3%,DVT:62.5%and EVT:75.0%.P=0.667).CONCLUSIONS:Age>60 and chemotherapy regimens containing fluorouracil were independent risk factors of PRT and hypertension with medication was associated with lower risk of PRT in patients with malignant tumors with PICCs receiving chemotherapy.PICCs-related SVT was a frequent type of PRT,which might need a better understanding and anticoagulant therapy in patients with malignant tumors with PICCs.