Safety and risk factors of PICC insertion in hematologic malignancy patients with thrombocytopenia: a retrospective study

Hematology patients often have severe thrombocytopenia and coagulation dysfunction. Despite the risk of bleeding, PICC insertion is still needed to reduce chemotherapy-related adverse reactions. Currently, there are no definitive indicators for predicting whether PICC placement increases bleeding risk in these patients. Additionally, large-scale studies on the safety of PICC insertion in hematology-oncology patients with platelet counts ≤ 50 × 10⁹/L and/or coagulation abnormalities are lacking. To evaluate the safety of PICC insertion in hematological oncology patients with a platelet concentration ≤ 50 × 10⁹/L and/or coagulation dysfunction through a large-sample retrospective study and to identify risk factors for bleeding after PICC placement. We retrospectively analyzed 1511 hematological patients with a platelet count ≤ 50 × 10⁹/L who underwent PICC insertion from February 2017 to January 2020, focusing on risk factors for bleeding within 24 h post-insertion. Multivariate analysis identified independent risk factors for bleeding within 24 h after PICC insertion as PT ≥ 13 s, platelet count ≤ 25 × 10⁹/L, and ADL score ≤ 95 points. Based on these three risk factors, patients were divided into low-risk (0-1 risk factors, 1% bleeding rate) and high-risk (≥ 2 risk factors, 7% bleeding rate) groups. When 0-1 risk factors are present, PICC insertion is safe even for patients with low platelet counts. If ≥ 2 risk factors exist, the decision to insert a PICC should consider the patient's clinical symptoms and needs. Blood product intervention does not affect the bleeding rate.