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

Abstract

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.

Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis

“…More importantly, whereas a prior study evaluating non-COVID-19 ICU patients found that patients with and without VTE had comparable mortality risk (16% vs 20%, P = 0.72) [66] , our meta-analysis shows that concomitant TE and COVID-19 is associated with 74% increased odds of death compared to COVID-19 patients without TE (13% vs 23%, OR: 1.74, P = 0.04). The risk of death in COVID-19 posed by TE is therefore not negligible.…”

Hypercoagulopathy in Severe COVID-19: Implications for Acute Care

“…This is significantly higher than described for non-COVID-related critical illness where there is a VTE prevalence between 5 and 30%. 3,4,[19][20][21][22][23][24][25][26] The direct comparison of studies describing the incidence of VTE is limited by the various thromboprophylactic regimes used, by differences in patient populations and by the differing imaging modalities used to establish a diagnosis of VTE. A few studies have compared patients with COVID-19 to historical cohorts of patients with acute respiratory distress syndrome (ARDS) or to critically ill patients with bacterial or viral pneumonia.…”

Barriers and challenges in the process of including critically ill patients in clinical studies

“…Patients included in the NORIDES study received standard treatment with additional Doppler ultrasound screening of veins to detect venous thromboembolism (VTE), and additional blood samples drawn from intravascular catheters for coagulation analyses. The main results of the NORIDES study describing the occurrence, risk factors and outcome of VTE is published [29], and additional results of coagulation tests are pending. In the NORIDES study, informed consent for participation was obtained from the patients or their next of kin in cases when patients were incompetent to give consent.…”

“…Data from all patients considered for inclusion in the NORIDES study were included in this study; a detailed description of the study population is provided elsewhere [29].…”