Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial

Arabi, Yaseen M.; Burns, Karen E. A.; Alsolamy, Sami; Alshahrani, Mohammed; Al-Hameed, Fahad; Arshad, Zia; Almaani, Mohammed; Hawa, Hassan; Mandourah, Yasser; Almekhlafi, Ghaleb; Aithan, Abdulsalam Al; Khalid, Imran; Rifai, Jalal; Rasool, Gulam; Abdukahil, Sheryl Ann; Jose, Jesna; Afesh, Lara; Al‐Dawood, Abdulaziz

doi:10.1007/s00134-019-05899-1

Cited by 24 publications

(33 citation statements)

References 23 publications

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“…Although our study has limitations, such as a small sample size, the results suggest a higher incidence of asymptomatic DVT in critically ill COVID-19 patients than reported by other studies in non-COVID-19 critically ill patients, where the incidence was approximately 10% (11,12).…”

Section: Discussioncontrasting

confidence: 59%

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Alfageme

Plaza

Collado

et al. 2020

Preprint

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BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

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Section: Discussioncontrasting

confidence: 59%

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Alfageme

Plaza

Collado

et al. 2020

Preprint

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“…Nevertheless, traditional signs and symptoms of VTE may be unreliable in critically ill patients, prohibiting a symptom-based dichotomization. Recently, in a pre-planned subgroup analysis from the PREVENT trial, Arabi and colleagues found a beneficial effect of VTE surveillance on 90-day mortality, which suggests that asymptomatic events do contribute to poor outcomes [20]. Only a well-designed randomized trial will be able to elucidate this question.…”

Section: Discussionmentioning

confidence: 99%

“…Several of the previous studies excluded patients at risk of bleeding, which may have led to selection bias [10,14,17]. Most studies screened all patients for 'asymptomatic' thrombosis, although the clinical significance of these events remains to be established [19,20].…”

Section: Introductionmentioning

confidence: 99%

Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies

et al. 2021

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Background The objective of this study was to describe the prevalence, incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients receiving contemporary thrombosis prophylaxis. Methods We conducted a pooled analysis of two prospective cohort studies. The outcomes of interest were in-hospital pulmonary embolism or lower extremity deep vein thrombosis (PE-LDVT), in-hospital nonleg deep vein thrombosis (NLDVT), and 90-day mortality. Multivariable logistic regression analysis was used to evaluate the association between predefined baseline prognostic factors and PE-LDVT or NLDVT. Cox regression analysis was used to evaluate the association between PE-LDVT or NLDVT and 90-day mortality. Results A total of 2208 patients were included. The prevalence of any venous thromboembolism during 3 months before ICU admission was 3.6% (95% CI 2.8–4.4%). Out of 2166 patients, 47 (2.2%; 95% CI 1.6–2.9%) developed PE-LDVT and 38 patients (1.8%; 95% CI 1.2–2.4%) developed NLDVT. Renal replacement therapy (OR 3.5 95% CI 1.4–8.6), respiratory failure (OR 2.0; 95% CI 1.1–3.8), and previous VTE (OR 3.6; 95% CI 1.7–7.7) were associated with PE-LDVT. Central venous catheters (OR 5.4; 95% CI 1.7–17.8) and infection (OR 2.2; 95% CI 1.1–4.3) were associated with NLDVT. Occurrence of PE-LDVT but not NLDVT was associated with increased 90-day mortality (HR 2.7; 95% CI 1.6–4.6, respectively, 0.92; 95% CI 0.41–2.1). Conclusion Thrombotic events are common in critically ill patients, both before and after ICU admittance. Development of PE-LDVT but not NLDVT was associated with increased mortality. Prognostic factors for developing PE-LDVT or NLDVT despite prophylaxis can be identified at ICU admission and may be used to select patients at higher risk in future randomized clinical trials. Trial registration NCT03773939.

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“…In term of prevention and early diagnosis, European guidelines [ 2 ] recommended against the routine use of compression Doppler ultrasound (DUS) screening of deep vein thrombosis in critically ill patients; however, in PREVENT study twice-weekly surveillance ultrasonography was associated with an increase in deep vein thrombosis (DVT) detection, reduction in diagnostic testing for non-lower limb DVT and pulmonary embolism (PE), earlier diagnosis of DVT and PE, and lower 90-day mortality [ 7 ].…”

Section: Highlightsmentioning

confidence: 99%

Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2

Pavoni¹,

Gianesello

2020

J Thromb Thrombolysis

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Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial

Cited by 24 publications

References 23 publications

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies

Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2

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