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E2015. Assessing Bleeding Complications from Tunneled Venous Central Line Placements in Patients on Antiplatelet and Anticoagulation Medication
Authors
  1. Steven Meng; University of Rochester
  2. Solomon Kim; University of Rochester
  3. Harris Chengazi; University of Rochester
  4. Timothy Baran; University of Rochester
  5. Devang Butani; University of Rochester
  6. Andrew Cantos; University of Rochester
Objective:
The Society of Interventional Radiology (SIR) guidelines regarding the management of patients receiving antiplatelet or anticoagulation medications for low risk procedures was most recently updated. Recommendations for holding these medications for central line placements were largely extrapolated from other low-risk procedure types. The purpose of our study is to evaluate the outcomes of central venous access performed on patients on antiplatelet or anticoagulation medications compared to patients with elevated international normalized ratio (INR) from liver disease, and a control group with patients not on antiplatelet or anticoagulation medications with normal INR.

Materials and Methods:
600 cases of tunneled, internal jugular central line procedures were identified, and chart reviewed. Exclusion criteria included exchange over wire catheter placement and patients who had anticoagulation held prior to procedure. 35 patients on antiplatelet therapy (high-dose aspirin, clopidogrel, or ticagrelor), 23 patients on anticoagulation therapy (warfarin or apixaban), and 38 patients with elevated INR secondary to cirrhosis were identified. A control group of 92 patients with normal range INR and not on anticoagulant medication was identified. Patients selected represented placement of small(6Fr) and large bore(13-15Fr) catheters in the inpatient and outpatient setting. Evidence for complications was investigated in all groups: drop in hematocrit, hematoma or bleeding at access site, and wound dehiscence. Morbidity and mortality were also followed in a 1-month period post procedure. Differences between groups were investigated with one-way ANOVA for continuous variables and chi-square test for categorical variables. Pairwise comparisons were performed using Tukey's test.

Results:
No significant difference seen in age (p=0.099), sex (p=0.25), or platelet level (p=0.052) between groups. Catheter size was significantly different between the elevated INR group and the anticoagulation group (p<0.0001). INR was significantly lower in the antiplatelet and control group. There was a significant difference in overall complication rate (p<0.0001) and 30-day mortality (p=0.0003), with the highest rate of both in the elevated INR group. However, no significant difference was seen in bleeding complication rates between groups (p=0.089). When stratified by specific medications and compared to elevated INR and normal INR controls, no significant difference was seen in all complication rates (p=0.40) and bleeding complications (p=0.94).

Conclusion:
Review of cases performed without holding antiplatelet and anticoagulant medications at our institution supports the new SIR consensus guidelines. Patients with elevated INR secondary to liver disease have increased 30-day mortality rates likely secondary to underlying critical illness. However, these patients do not appear to have increased bleeding risk. Further investigation into other medications not evaluated here is also warranted to fully investigate the new guidelines and their implications.