Venous Thromboembolism in Critically Ill Medical Patients Receiving Chemoprophylaxis

Fontaine, G; Vigil, E; Wohlt, Paul; Lloyd, James F.; Evans, R. Scott; Collingridge, David S.; Stevens, Scott M.; Woller, Scott C.

doi:10.1177/1076029615604048

Cited by 16 publications

(12 citation statements)

References 47 publications

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“…Results of the meta-analysis revealed that critically ill patients with COVID-19 have a high prevalence of VTE, despite the use of the present routine prophylactic anticoagulation. In a previous large-scale cross-sectional study that included 11,111 critically ill medical patients who received chemoprophylaxis, the overall prevalence of VTE was 6.5% ( 40 ), which is significantly lower than that in critically ill patients with COVID-19 found in the meta-analysis (28.4%). In a previous meta-analysis, critically ill patients were admitted in the ICU, and the mean prevalence of DVT was reported to be 12.7% ( 14 ), which was considerably lower than that for the critically ill patients with COVID-19 found in the present meta-analysis (25.6%).…”

Section: Discussionmentioning

confidence: 72%

Prevalence of Venous Thromboembolism in Critically Ill Patients With Coronavirus Disease 2019: A Meta-Analysis

Liu

Cai

et al. 2021

Front. Med.

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Background: Accumulating evidence suggests that coronavirus disease 2019 (COVID-19) is associated with hypercoagulative status, particularly for critically ill patients in the intensive care unit. However, the prevalence of venous thromboembolism (VTE) in these patients under routine prophylactic anticoagulation remains unknown. A meta-analysis was performed to evaluate the prevalence of VTE in these patients by pooling the results of these observational studies.Methods: Observational studies that reported the prevalence of VTE in critically ill patients with COVID-19 were identified by searching the PubMed and Embase databases. A random-effect model was used to pool the results by incorporating the potential heterogeneity.Results: A total of 19 studies with 1,599 patients were included. The pooled results revealed that the prevalence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE) in critically ill patients with COVID-19 was 28.4% [95% confidence interval (CI): 20.0–36.8%], 25.6% (95% CI: 17.8–33.4%), and 16.4% (95% CI: 10.1–22.7%), respectively. Limited to studies, in which all patients received routine prophylactic anticoagulation, and the prevalence for VTE, DVT, and PE was 30.1% (95% CI: 19.4–40.8%), 27.2% (95% CI: 16.5–37.9%), and 18.3% (95% CI: 9.8%−26.7%), respectively. The prevalence of DVT was higher in studies with routine screening for all patients, when compared to studies with screening only in clinically suspected patients (47.5% vs. 15.1%, P < 0.001).Conclusion: Critically ill patients with COVID-19 have a high prevalence of VTE, despite the use of present routine prophylactic anticoagulation.

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Section: Discussionmentioning

confidence: 72%

Prevalence of Venous Thromboembolism in Critically Ill Patients With Coronavirus Disease 2019: A Meta-Analysis

Liu

Cai

et al. 2021

Front. Med.

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“…central venous access), the use of vasopressors and other medications, blood product transfusion, mechanical ventilation, and certain acquired thrombophilias. 41,42 While this glimpse of evidence may partially support the use of therapeutic-dose anticoagulants in patients with these specific conditions, 12,13 2 main factors must be taken into consideration before implementing such treatment in clinical practice. Firstly, it is possible that only particular subgroups of criticallyill patients with certain risk factors could benefit from therapeutic-dose anticoagulation, as Klok et al reported no mortality benefits among those receiving therapeutic-dose anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…central venous access), the use of vasopressors and other medications, blood product transfusion, mechanical ventilation, and certain acquired thrombophilias. 41,42…”

Section: Discussionmentioning

confidence: 99%

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Wijaya

Andhika

Huang

2020

Clin Appl Thromb Hemost

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The incidence of venous thromboembolism (VTE) events in patients with COVID-19 treated with a standard thromboprophylaxis dose of anticoagulants remains high. We conducted a systematic review in order to explore the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19. A systematic search was carried out using the electronic databases of PubMed, EuropePMC, and the Cochrane Central Database, using specific keywords. All articles that fulfilled the inclusion criteria were included in the qualitative analysis. There were 8 observational studies included in the final qualitative analysis. Quality assessment using the Newcastle-Ottawa Scale (NOS) showed a mean score of 7.5 ± 1.06, indicating moderate to high quality of the studies. Three retrospective cohort studies reported a reduction in the mortality rate, while 6 other studies showed no mortality benefits among patients with COVID-19 treated with therapeutic-dose anticoagulation. There was a slight tendency toward a reduction in the mortality rate among mechanically-ventilated patients with COVID-19 receiving therapeutic-dose anticoagulation. Bleeding events and thrombotic complications among patients receiving therapeutic-dose anticoagulation were reported in 3 studies. Although it is too soon to draw any conclusions, this systematic review draws attention to current evidence regarding the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19.

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“…Many studies in critically ill, non-critically ill, and patients with sepsis support this association. 18,39,40 In patients with sepsis and critically ill medical patients receiving thromboprophylaxis, CVC increased the risk of VTE by an OR of 2.82 (95% CI 1.07-7.38) and 2.64 (95% CI 1.87-3.72), respectively. 18,39 Central venous catheter–related thrombosis is an important complication of CVC insertion 41 and a risk factor for upper extremity DVT.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism in Neurocritical Care Patients

Viarasilpa

Panyavachiraporn

Jordan

et al. 2019

J Intensive Care Med

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Background: Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients. Methods: We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation–perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded. Results: Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, P = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; P < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P = .007). Conclusions: Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.

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Venous Thromboembolism in Critically Ill Medical Patients Receiving Chemoprophylaxis

Abstract: The rate of VTE in critically ill medical patients remains high despite standard chemoprophylaxis. Obesity is among 8 risk factors independently associated with 90-day VTE.

Cited by 16 publications

References 47 publications

Prevalence of Venous Thromboembolism in Critically Ill Patients With Coronavirus Disease 2019: A Meta-Analysis

Prevalence of Venous Thromboembolism in Critically Ill Patients With Coronavirus Disease 2019: A Meta-Analysis

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Venous Thromboembolism in Neurocritical Care Patients

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