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

Abstract

Few prospective studies have reported the cumulative incidence of venous thromboembolism (VTE) in the intensive care unit (ICU), especially for patients receiving guideline-recommended VTE prophylaxis. We aimed to design a prospective observational study to investigate the cumulative incidence and risk factors of ICU-acquired VTE for those populations. We prospectively studied 281 consecutively included patients in the ICU at a single center. All patients provided informed consent. Patients received ultrasound evaluation and were followed for VTE before ICU discharge or within 28 days of ICU stay. The type of VTE thromboprophylaxis was also recorded for all patients. Variables from univariate analyses that were associated with VTE were included in the binary logistic regression analysis to determine VTE predictors. The cumulative VTE incidence with 95% confidence interval (CI) was estimated using Kaplan–Meier methods. Patients had a median age of 60 years (range, 18–89) and an acute physiology and chronic health evaluation II score of 17 (range, 4–36). Despite all patients receiving guideline-recommended thromboprophylaxis, the cumulative incidence of VTE at 7, 14, 21, and 28 days was 4.45% (95% CI 2.55–7.71), 7.14% (95% CI 4.61–10.97), 7.53% (95% CI 4.92–11.43), and 9.55% (95% CI 6.55–13.81), respectively. Central venous catheter use ( P = .002, odds ratio [OR] = 4.50), Caprini score ( P = .012, OR = 1.20), and ICU length of stay ( P = .006, OR = 1.08) were independent risk factors related to the incidence of VTE for patients admitted to the ICU. Our prospective observational study found that the 28-day cumulative incidence of VTE was relatively high for patients admitted to the ICU, despite the use of guideline-recommended thromboprophylaxis. Patients with femoral central venous catheter, prolonged ICU length of stay, or a high Caprini score may have an increased risk of developing VTE.

COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection

“…Acute inflammation, as measured by elevations in these markers, has previously been associated with increased thrombotic and bleeding risk in patients without COVID-19 19,20 ; indeed, we found significant correlations between D-dimer levels and each measured inflammatory marker (Figure 1). Given previously reported 14-day cumulative VTE rates of 7% to 8% in critically ill patients without COVID-19 receiving standard heparinbased thromboprophylaxis, 21 our observed rate of 7.6% in critically ill patients receiving similar prophylactic treatment over a median follow-up of 10 days was comparable. Likewise, to contextualize our major bleeding rate of 5.6% in the critically ill, a large prospective study of bleeding events in 3746 critically ill patients without COVID-19 identified major bleeding (defined similarly as in our study) in 208 patients (5.6%).…”

Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

“…This incidence of thromboembolic events is considerably lower than the 15% to 42% incidence reported in critically ill patients with COVID-19 in Europe [10][11][12][13][14] and is more consistent with the incidence reported in critically ill pa-tients without COVID-19. 15 Understanding the reason for these differences will be important as hypercoagulability in COVID-19 is pursued as a potential therapeutic target. 16 This study identified considerable interhospital variation in the administration of medications and supportive therapies intended to treat COVID-19 and associated organ injury.…”

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

“…Previous analyses have estimated a significant lower incidence of acute PE in the ICU population, which generally increase in mechanically ventilated patients [34,35]. The high incidence of acute PE in critically ill patients may reflect a more severe pro-coagulant state [36][37][38][39].…”