Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange.

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2022-08

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Abstract

Background

For inpatients undergoing therapeutic plasma exchange (TPE) in the United States, the primary mode of venous access is the central venous catheter (CVC). To evaluate the impact of CVC on thrombosis outcomes of patients undergoing TPE, we analyzed the National Inpatient Sample (NIS) database.

Study design and methods

In a cross-sectional analysis of the NIS, we identified hospital discharges of adult patients treated with TPE. Cases were classified into two groups based on CVC status. The primary outcome was thrombosis. Secondary outcomes were major bleeding, packed red blood cell (PRBC) transfusion, in-hospital mortality, hospital length of stay (LOS), and charges.

Results

Among 9863 TPE-treated discharges, CVC was used in 5988 (60%). These numbers correspond to weighted national estimates of 49 315 and 29 940, respectively. There was a positive and significant association between CVC and thrombosis (OR = 1.23, 95% 1.04-1.46, P = 0.0174), PRBC transfusion (OR = 1.15, 95% 1.03-1.29, P = 0.0121), in-hospital mortality (OR = 1.36, 95% 1.10-1.68, P = 0.0043), hospital LOS (15.63 vs 12.45 days, P < 0.0001) and hospital charges ($166 387 vs. $132 655, P < 0.0001).

Conclusion

In hospitalized patients undergoing TPE, CVC use is associated with increased rates of thrombosis. Future studies are needed to investigate strategies to decrease CVC use and/or prevent CVC-associated complications in TPE-treated inpatients.

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Humans, Thrombosis, Plasma Exchange, Catheterization, Central Venous, Cross-Sectional Studies, Adult, Inpatients, United States, Central Venous Catheters

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https://hdl.handle.net/10161/27006

Published Version (Please cite this version)

10.1002/jca.21975

Publication Info

Soares Ferreira Júnior, Alexandre, Stephen H Boyle, Maragatha Kuchibhatla and Oluwatoyosi A Onwuemene (2022). Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange. Journal of clinical apheresis, 37(4). pp. 340–347. 10.1002/jca.21975 Retrieved from https://hdl.handle.net/10161/27006.

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Scholars@Duke

Kuchibhatla

Maragatha Kuchibhatla

Professor of Biostatistics & Bioinformatics

Statistical research methodology, analysis of repeated measurements, latent growth curve models, latent class growth models, classification and regression trees,
designing clinical trials, designing clinical trials in psychiatry -- both treatment and non-treatment
trials in various comorbid populations.

Onwuemene

Oluwatoyosi Adefunke Onwuemene

Associate Professor of Medicine

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