Michigan Risk Score for PICC-Related Thrombosis
Predicts risk of DVT in patients with peripherally inserted central catheter (PICC).
Limited external validation performed; use with caution.
Advice
- Risk of upper extremity DVT increases with Michigan Risk Score Class.
- Compared with Class I:
- Class II has a twofold higher risk of thrombosis.
- Class III has a threefold higher risk.
- Class IV has an eightfold higher risk.
- A Class I score is not necessarily “safe” (incidence of DVT ~1%).
- Carefully consider the risks and benefits of using a PICC, especially if the risk of thrombosis is high.
- Strongest predictors for DVT risk were:
- Triple-lumen PICCs.
- PICCs placed in patients with a history of VTE in the past 30 days.
- PICCs placed in the setting of active cancer.
- Consider alternative devices (e.g. central venous catheters, ports, tunneled catheters) that can be placed in larger veins, if appropriate.
Critical Actions
- This tool is meant to risk stratify patients who have a potential risk for PICC-related upper extremity DVT, not to diagnose DVT.
- If deemed appropriate, anticoagulation should not be withheld from patients who require it as part of the treatment for their diagnosis.
- Prior to initiating any anticoagulant therapy, a patient’s bleeding risk should be evaluated.