Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography

Abstract

Introduction: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. Methods: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Results: Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence ( P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis ( P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay ( P = .35) or mortality ( P = .34). Conclusions: Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

Disease-Related Risk Factors for CVC-Related Symptomatic Thrombosis in Surgical ICU Inpatients

“…Otherwise, mechanical prophylaxis to prevent thrombus should be performed. In addition, this study also suggested that age, BMI, APACHE II score, length of ICU stay and other factors were signi cantly different in the comparison between the two groups, which was basically consistent with the results of previous studies 12,16,17,43 .…”

“…This study also noted that a long duration of CVC intubation 42 and long endotracheal intubation 16,18 could increase symptomatic CRVT occurrence in SICU patients. In this study population, anticoagulation therapy was insu cient due to anticoagulation contraindication, and the comparison of anticoagulation therapy between the two groups was statistically signi cant (P = 0.005), which may also increase the occurrence of symptomatic CRVT.…”

“…The incidence of thrombosis was 16%, and the catheter usage rate of patients with thrombosis was 55.26%. However, the incidence of symptomatic CRVT was not further analyzed 16 . Chen, Y. et al studied symptomatic thrombosis associated with peripherally inserted CVC in cancer patients and found that the incidence of symptomatic CRVT was 6.7% 17 .…”

The cumulative venous thromboembolism incidence and risk factors in intensive care patients receiving the guideline-recommended thromboprophylaxis

“…However, other studies also showed that differences in ICU stay were not significant between the VTE and non-VTE groups. [29,30] CVC use was an important risk factor for VTE, especially if it was inserted in the femoral vein. The incidence of VTE ranged from 10% to 69% with a femoral catheter.…”

Venous thrombosis, thromboembolism, biomarkers of inflammation, and coagulation in coronavirus disease 2019

“…Studies of VTE rates in critically-ill patients prior to the COVID-19 pandemic report an incidence of 16% upon clinically-indicated imaging 26 and from 8 to 37% in prospectively screened patients regardless of symptoms. 27 , 28 , 29 Recent studies suggest hospitalized COVID-19 patients have an increased predisposition for thrombotic events, with an incidence ranging from 20-36% in the subset receiving clinically-indicated imaging.…”