Risk of catheter-associated deep venous thrombosis in inflammatory bowel disease.
BACKGROUND
Inflammatory bowel disease confers a hypercoagulable state. A large number of these patients require central venous access in the form of peripherally inserted central catheters for long-term intravenous therapies. Our clinical observations suggested that these patients had a higher incidence of catheter-associated deep venous thrombosis than that of the general population.


OBJECTIVE
The aim of this study was to examine the relationship between IBD and catheter-associated deep venous thrombosis.


METHODS
A retrospective chart review was conducted of all patients who underwent peripherally inserted central catheter line placement between 2009 and 2011.


METHODS
This study was performed at a single-institution tertiary referral center.


METHODS
All patients who underwent peripherally inserted central catheter line placement were identified.


METHODS
The risk of catheter-associated deep venous thrombosis in IBD patients was assessed. This risk was compared with known risk factors such as malnutrition, malignancy, diabetes mellitus, and tobacco use. Multivariate analysis was performed. Catheter size, indication for placement, and vein location of catheter-associated deep venous thrombosis were identified in the IBD population.


RESULTS
There were 7179 peripherally inserted central catheter lines placed during the study period; the overall incidence of catheter-associated deep venous thrombosis was 2.1% (148/7179). The incidence of catheter-associated deep venous thrombosis among patients with IBD was 6.8% (9/132). The incidence of catheter-associated deep venous thrombosis among non-IBD patients was 1.9% (139/7047) (relative risk, 3.5; 95% CI, 1.8-6.6; p < 0.001). The incidence of catheter-associated deep venous thrombosis was increased for patients with malnutrition (4.8%, 30/628, p < 0.001) and increasing age (95% CI, 1.01-1.12; p = 0.02). There was no increased incidence of catheter-associated deep venous thrombosis for patients with diabetes mellitus (1.6%, 25/1574, p < 0.14), malignancy (2.8%, 30/1041, p = 0.06), or tobacco use (1.6%, 31/1938, p = 0.10). After multivariate analysis, IBD, malnutrition, and increasing age were found to be significant risk factors for the development of catheter-associated deep venous thrombosis.


CONCLUSIONS
The inability to track the number of catheter days, the inaccuracy of administrative data, the lack of outpatient follow-up, and the small number of events in the study cohort were limitations of this study.


CONCLUSIONS
This is the first study to demonstrate IBD as an independent risk factor to the development of catheter-associated deep venous thrombosis. The placement of a peripherally inserted central catheter line in IBD should be utilized selectively.
Department of Surgery, Albany Medical College, Albany, New York.
Avinash
A
Bhakta
Marcel
M
Tafen
Mushfique
M
Ahmed
Ashar
A
Ata
Christa
C
Abraham
David
D
Bruce
Brian T
BT
Valerian
Edward C
EC
Lee
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D062905:Central Venous Catheters / Q000009:adverse effects; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology