Inadequate Venous Thromboembolism Risk Stratification Predicts Venous Thromboembolic Events in Surgical Intensive Care Unit Patients

Pannucci, Christopher J.; Obi, Andrea; Alvárez, Rafael; Abdullah, Newaj; Nackashi, Andrew; Hu, Hsou Mei; Bahl, Vinita; Henke, Peter K.

doi:10.1016/j.jamcollsurg.2014.01.046

Cited by 37 publications

(38 citation statements)

References 27 publications

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“…Abdominal surgery may be associated with VTE in the present study because most such operations were performed due to abdominal malignancy. In contrast to a previous study, we observed that low severity of illness was related to an increased risk of VTE . We also found that patients with and without severe AKI treated with CRRT had similar rates of VTE.…”

Section: Discussionmentioning

confidence: 92%

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

Beitland

Wimmer

Lorentsen

et al. 2019

Acta Anaesthesiol Scand

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Background:The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. Methods: Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason.Results: Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58-0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72). Conclusion:Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.

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Section: Discussionmentioning

confidence: 92%

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

Beitland

Wimmer

Lorentsen

et al. 2019

Acta Anaesthesiol Scand

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“…Specifically, CAM inhibitor experiments as performed in this paper preliminarily suggest a possible major role for ICAM-1 in the amplified thrombotic response seen with acute Gram-negative pneumonia. While pharmacomechanical VTE prophylaxis is effective, critically ill patients often develop VTE with appropriate thromboprophylaxis [34]. Our experimental data suggest that activation of the vein wall, and possibly PMN activation, plays a role in the mouse model of Gram-negative pneumonia-associated VT and lays the foundation for future studies on differential molecular pathway targets in Gram-negative pneumonia-associated DVT.…”

Section: Discussionmentioning

confidence: 81%

“…Pneumonia confers a major risk for VTE development with associated morbidity and mortality [33]. Current VTE prophylaxis regimens may be ineffective at preventing VTE formed under these conditions and thus an improved understanding of the underpinning molecular mechanisms is necessary [34]. With a series of experiments, examining for the first time large-vein-wall response to Gram-negative pneumonia and VT formed under conditions of pneumonia, we demonstrate that upregulation in deep-vein-wall CAMs is elevated with lung inflammation secondary to Gram-negative infection but not under conditions of sterile lung inflammation from mechanical lung injury.…”

Section: Discussionmentioning

confidence: 99%

Gram-Negative Pneumonia Alters Large-Vein Cell-Adhesion Molecule Profile and Potentiates Experimental Stasis Venous Thrombosis

Andrea

Andraska

Kanthi³

et al. 2016

J Vasc Res

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Background/Aims: Pneumonia is a significant risk factor for the development of venous thrombosis (VT). Cell-adhesion molecules (CAMs) are linked to the pathogenesis of both pneumonia and VT. We hypothesized that remote infection would confer a prothrombogenic milieu via systemic elevation of CAMs. Methods: Lung injury was induced in wild-type (C57BL/6) mice by lung contusion or intratracheal inoculation with Klebsiella pneumoniae or saline controls. K. pneumoniae-treated mice and controls additionally underwent inferior vena cava (IVC) ligation to generate VT. Results: Lung-contusion mice demonstrated no increase in E-selectin or P-selectin whereas mice infected with K. pneumoniae demonstrated increased circulating P-selectin, ICAM-1, VCAM-1 and thrombin-antithrombin (TAT) complexes. Mice with pneumonia formed VT 3 times larger than controls, demonstrated significantly more upregulation of vein-wall and systemic CAMs, and formed erythrocyte-rich thrombi. Conclusion: Elevated CAM expression was identified in mice with pneumonia, but not lung contusion, indicating that the type of inflammatory stimulus and the presence of infection drive the vein-wall response. Elevation of CAMs was associated with amplified VT and may represent an alternate mechanism by which to target the prevention of VT.

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“…22,25 Inadequate or inaccurate risk estimation has been shown to lead to poor outcomes. 26 The causes of this are multifactorial. Alert fatigue is a phenomenon, whereby providers begin to ignore alerts in the electronic medical record when alerts become increasingly common.…”

Section: The Institution Of Risk Assessment In the Hospital Systemmentioning

confidence: 99%

“…There is recent research that suggests that overly cumbersome RAMs decrease provider compliance. 26,[28][29][30] It has further been suggested that RAMs with fewer inputs can be as or more effective than more cumbersome models such as Caprini. 31…”

Section: The Institution Of Risk Assessment In the Hospital Systemmentioning

confidence: 99%

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Jacobs

Pannucci

2017

Semin Thromb Hemost

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Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

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Inadequate Venous Thromboembolism Risk Stratification Predicts Venous Thromboembolic Events in Surgical Intensive Care Unit Patients

Cited by 37 publications

References 27 publications

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

Gram-Negative Pneumonia Alters Large-Vein Cell-Adhesion Molecule Profile and Potentiates Experimental Stasis Venous Thrombosis

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

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