PB0405 - Association between anticoagulation strategy and venous recanalization in patients with peripherally inserted central catheter related upper extremity venous thrombosis

Background: Anticoagulation regimens for peripherally inserted central catheter related upper extremity venous thrombosis (PICC-UEVT) are mostly based on evidence of lower extremity venous thrombosis, the effectiveness and safety of reduced-dose anticoagulation in the UEVT is rarely reported.

Aims: To describe the anticoagulation regimens after the diagnosis of PICC-UEVT with exploring the influencing factors of anticoagulation decision-making, and to investigate the effectiveness and safety of adjusted-dose anticoagulation for PICC-UEVT.

Methods: Adult patients with PICC-UEVT diagnosed by venous ultrasound from January 2015 to December 2021 were included in this single-center retrospective cohort study. Patients were divided into therapeutic-dose and adjusted-dose groups. Upper extremity venous recanalization was defined as the effectiveness outcome and hemorrhage associated with anticoagulation was defined as the safety outcome. Survival analysis and COX regression were performed.

Results: Of the 215 patients diagnosed with PICC-UEVT, 141 patients were ultimately included, including 37 patients with therapeutic dose and 111 patients with adjusted dose. Compared to patients with therapeutic dose, those with adjusted dose had significant higher age and the proportion of estimated glomerular filtration rate < 60 ml/min/1.73 m2, but the proportion of those aged≥70 years and body mass index were similar. And no significant differences were observed in the age, gender, platelet count and comorbidities. The recanalization rate was slightly higher in the therapeutic-dose group than adjusted-dose group (71.4%（15） vs. 60.6%（40）, P=0.525), and Kaplan-Meier survival analysis suggested that there was no significant difference in the venous recanalization, with a median follow-up time of (15.0d vs. 17.5d, P=0.297). The incidence of major bleeding was low in both groups (1/55 VS. 1/32, P=0.785).

Conclusion(s): Some patients reached venous recanalization after application of adjusted-dose anticoagulation, and venous recanalization rate was similar compared with the therapeutic-dose group. This study provides evidence for the effectiveness and safety of applying adjusted-dose anticoagulation, but prospective studies with regular follow-up are needed.