Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital

Chen, Xiaolan; Huang, Jiyan; Liu, Jingxuan; Deng, Hui; Pan, Lei

doi:10.21037/apm-21-464

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…The Caprini risk assessment model can effectively predict the risk of VTE occurrence in patients admitted to the internal medicine intensive care unit and cerebrovascular disease patients. 23 – 25 …”

Section: Discussionmentioning

confidence: 99%

External Validation of the Risk Assessment Model of Venous Thromboembolism in Multicenter Internal Medicine Inpatients

Chen,

Shi,

Chang

et al. 2024

Clin Appl Thromb Hemost

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To external validate the risk assessment model (RAM) of venous thromboembolism (VTE) in multicenter internal medicine inpatients. We prospectively collected 595 internal medical patients (310 with VTE patients, 285 non-VTE patients) were from Beijing Shijitan Hospital, Beijing Chaoyang Hospital, and the respiratory department of Beijing Tsinghua Changgeng Hospital from January 2022 to December 2022 for multicenter external validation. The prediction ability of Caprini RAM, Padua RAM, The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) RAM, and Shijitan (SJT) RAM were compared. This study included a total of 595 internal medicine inpatients, including 242 (40.67%) in the respiratory department, 17 (2.86%) in the respiratory intensive care unit, 49 (8.24%) in the neurology department, 34 (5.71%) in the intensive care unit, 26 (4.37%) in the geriatric department, 22 (3.70%) in the emergency department, 71 (11.93%) in the nephrology department, 63 (10.59%) in the cardiology department, 24 (4.03%) in the hematology department, 6 (1.01%) in the traditional Chinese medicine department, 9 (1.51%) cases in the rheumatology department, 7 (1.18%) in the endocrinology department, 14 (2.35%) in the oncology department, and 11 (1.85%) in the gastroenterology department. Multivariate logistic regression analysis showed that among internal medicine inpatients, age > 60 years old, heart failure, nephrotic syndrome, tumors, history of VTE, and elevated D-dimer were significantly correlated with the occurrence of VTE ( P < .05). The incidence of VTE increases with the increase of D-dimer. It was found that the effectiveness of SJT RAM (AUC = 0.80 ± 0.03) was better than Caprini RAM (AUC = 0.74 ± 0.03), Padua RAM (AUC = 0.72 ± 0.03) and IMPROVE RAM (AUC = 0.52 ± 0.03) ( P < .05). The sensitivity and Yoden index of SJT RAM were higher than those of Caprini RAM, Pauda RAM, and IMPROVE RAM ( P < .05), but specificity was not significantly different between the 4 models ( P > .05). The SJT RAM derived from general hospitalized Chinese patients has effective and better predictive ability for internal medicine inpatients at risk of VTE.

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Section: Discussionmentioning

confidence: 99%

External Validation of the Risk Assessment Model of Venous Thromboembolism in Multicenter Internal Medicine Inpatients

Chen,

Shi,

Chang

et al. 2024

Clin Appl Thromb Hemost

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“…Wang et al showed that hypertension, cancer or systemic cancer treatments, diabetes, coronary heart disease, heart failure, respiratory failure, acute myocardial infarction, and ischemic stroke were associated with the risk of VTE in older adult ICU patients [ 28 ]. Chen et al [ 12 ] indicated that gender (male), bedridden for > 72 h, pneumonia, history of DVT, diabetes, coronary heart disease, glucocorticoids, PaO 2 , mechanical ventilation, CRRT, hemoglobin level, PT, INR, and D-dimer level were risk factors for VTE in critically ill older adult patients. The discrepancies in risk factors among studies might be due to the exact ICU population, local clinical practice, variables being examined, and different definitions used.…”

Section: Discussionmentioning

confidence: 99%

“…Length of stay in the ICU and older age are two important risk factors for DVT [ 7 , 8 ], while further research needs to be conducted to clarify the exact risk factors for DVT in critically ill older adult patients. A recent study showed that the risk factors for venous thromboembolism in critically ill older adult patients were sex (male), bedridden for > 72 h, pneumonia, history of DVT, diabetes, coronary heart disease, glucocorticoids, PaO 2 level, mechanical ventilation, continuous renal replacement therapy (CRRT), prothrombin time (PT), international normalized ratio (INR), and D-dimer level [ 12 ], while it was a retrospective study with a risk of bias. Therefore, prospective cohort studies are necessary to identify the risk factors of DVT in critically ill older adult patients.…”

Section: Introductionmentioning

confidence: 99%

The risk factors for deep venous thrombosis in critically ill older adult patients: a subgroup analysis of a prospective, multicenter, observational study

Junhai

Huang

et al. 2022

BMC Geriatr

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Background Older adult patients mainly suffer from multiple comorbidities and are at a higher risk of deep venous thrombosis (DVT) during their stay in the intensive care unit (ICU) than younger adult patients. This study aimed to analyze the risk factors for DVT in critically ill older adult patients. Methods This was a subgroup analysis of a prospective, multicenter, observational study of patients who were admitted to the ICU of 54 hospitals in Zhejiang Province from September 2019 to January 2020 (ChiCTR1900024956). Patients aged > 60 years old on ICU admission were included. The primary outcome was DVT during the ICU stay. The secondary outcomes were the 28- and 60-day survival rates, duration of stay in ICU, length of hospitalization, pulmonary embolism, incidence of bleeding events, and 60-day coagulopathy. Results A total of 650 patients were finally included. DVT occurred in 44 (2.3%) patients. The multivariable logistic regression analysis showed that age (≥75 vs 60-74 years old, odds ratio (OR) = 2.091, 95% confidence interval (CI): 1.308-2.846, P = 0.001), the use of analgesic/sedative/muscarinic drugs (OR = 2.451, 95%CI: 1.814-7.385, P = 0.011), D-dimer level (OR = 1.937, 95%CI: 1.511-3.063, P = 0.006), high Caprini risk score (OR = 2.862, 95%CI: 1.321-2.318, P = 0.039), basic prophylaxis (OR = 0.111, 95%CI: 0.029-0.430, P = 0.001), and physical prophylaxis (OR = 0.322, 95%CI: 0.109-0.954, P = 0.041) were independently associated with DVT. There were no significant differences in 28- and 60-day survival rates, duration of stay in ICU, total length of hospitalization, 60-day pulmonary embolism, and coagulation dysfunction between the two groups, while the DVT group had a higher incidence of bleeding events (2.6% vs. 8.9%, P < 0.001). Conclusion In critically ill older adult patients, basic prophylaxis and physical prophylaxis were found as independent protective factors for DVT. Age (≥75 years old), the use of analgesic/sedative/muscarinic drugs, D-dimer level, and high Caprini risk score were noted as independent risk factors for DVT. Trial registration Chinese Clinical Trial Registry (ChiCTR1900024956).URL: http://www.chictr.org.cn/listbycreater.aspx.

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“…Six trials enrolled 10,112 critically ill medical and surgical patients to assess individual VTE risk by the CRS (Table S16, Supplemental Digital Content 1, http://links.lww.com/SLA/ E469). [76][77][78][79][80][81] The incidence of VTE varied between 3.1% and 8.9% while symptomatic events were detected in 3.1% to 7.9% of cases. The Caprini score ranged from 0 to 21.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties

et al. 2023

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Objective: Estimation of the specific thresholds of the Caprini risk score (CRS) that are associated with the increased incidence of venous thromboembolism (VTE) across different specialties, including identifying the highest level of risk. Background: Accurate risk assessment remains an important but often challenging aspect of VTE prophylaxis. One well-established risk assessment model is CRS, which has been validated in thousands of patients from many different medical and surgical specialties. Methods: A search of MEDLINE and the Cochrane Library was performed in March 2022. Manuscripts that reported on (1) patients admitted to medical or surgical departments and (2) had their VTE risk assessed by CRS and (3) reported on the correlation between the score and VTE incidence, were included in the analysis. Results: A total of 4562 references were identified, and the full text of 202 papers was assessed for eligibility. The correlation between CRS and VTE incidence was reported in 68 studies that enrolled 4,207,895 patients. In all specialties, a significant increase in VTE incidence was observed in patients with a CRS of ≥ 5. In most specialties thresholds of ≥ 7, ≥ 9, and ≥ 11 to 12 were associated with dramatically increased incidences of VTE. In cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥ 9 and ≥ 11 to 12 scores the VTE incidence was extremely high (ranging from 13% to 47%). Conclusion:The Caprini score is being used increasingly to predict VTE in many medical and surgical specialties. In most cases, the VTE risk for individual patients increases dramatically at a threshold CRS of 7 to 11.

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Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital

Cited by 8 publications

References 20 publications

External Validation of the Risk Assessment Model of Venous Thromboembolism in Multicenter Internal Medicine Inpatients

External Validation of the Risk Assessment Model of Venous Thromboembolism in Multicenter Internal Medicine Inpatients

The risk factors for deep venous thrombosis in critically ill older adult patients: a subgroup analysis of a prospective, multicenter, observational study

The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties

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