Causal analysis of platelet count and bleeding risk after peripherally inserted central catheter in patients with cardiovascular diseases

Tian Chunying; Ren Yingchun; Tang Xue; Wang Xinyu; Song Lijun

doi:10.3760/j.issn.1673-4777.2026.06.007

Abstract：Objective To investigate the influencing factors of bleeding after peripherally inserted central catheter(PICC)placement in patients with cardiovascular diseases,and to clarify the causal association and mediating effect.Methods Medical records of 319 cardiovascular disease patients who underwent PICC placement in Beijing Anzhen Hospital,Capital Medical University from October 2024 to August 2025 were retrospectively collected.Patients were divided into bleeding group(61 cases)and non-bleeding group(258 cases)according to bleeding status.Demographic data,disease diagnosis,medication and other information were collected.With bleeding after PICC placement as the outcome variable,independent risk factors and pathways were identified by multivariate Logistic regression,causal association and mediation analysis.Results There were significant differences in puncture site,proportion of atrial fibrillation,thrombocytopenia,proportion of combined rheumatic heart disease,history of valve replacement surgery,platelet count,D-dimer and fibrinogen levels between the two groups(all P＜0.05).Multivariate Logistic regression analysis showed that thrombocytopenia,atrial fibrillation and history of valve replacement surgery were independent risk factors for PICC-related bleeding,while elevated D-dimer level and puncture at basilic vein were protective factors(all P＜0.05).Mediation analysis showed that platelet count was an important mediator between thrombocytopenia and PICC-related bleeding.Thrombocytopenia could indirectly increase bleeding risk by reducing platelet count,with an indirect effect value of 0.065(95％confidence interval:0.008-0.126).There was a non-linear association between platelet count and bleeding risk after PICC placement,and the bleeding risk increased significantly when platelet count was lower than 200 × 109/L.Conclusions Thrombocytopenia,atrial fibrillation,history of valve replacement surgery,lower D-dimer level and non-basilic vein puncture are closely related to bleeding risk after PICC placement in cardiovascular disease patients.Platelet count plays a partial mediating role in the association between thrombocytopenia and PICC-related bleeding,and a level below 200 × 109/L increases the bleeding risk.