VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

Kaplan, David; Casper, T. Charles; Elliott, C. Gregory; Men, Shaohua; Pendleton, Robert C.; Kraiss, Larry W.; Weyrich, Andrew S.; Grissom, Colin K.; Zimmerman, Guy A.; Rondina, Matthew T.

doi:10.1378/chest.15-0287

Cited by 216 publications

(229 citation statements)

References 25 publications

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“…The number of missed heparin doses may have also predisposed patients to VTE in this study, but this may capture a more pragmatic use of heparin prophylaxis in daily clinical practice. Compliance rates in this study were similar to compliance rates with twice/day or 3 times/day heparin in pragmatic prospective studies that found no effect of compliance on VTE development . To isolate a higher severity of illness, we included only patients who stayed at least 2 days in an ICU setting with 24 hours or more of mechanical ventilation on the basis that mechanical ventilation and immobility pose the highest risk of VTE in this population despite heparin prophylaxis .…”

Section: Discussionmentioning

confidence: 81%

Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

et al. 2019

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Background Venous thromboembolism (VTE) occurs frequently in critically ill patients without heparin prophylaxis. Although heparin prevents VTE, VTEs occur frequently despite prophylaxis. A higher heparin dosage may be more effective for preventing VTE. Methods A retrospective study was conducted using the Premier Incorporated Perspective Database to evaluate comparatively the effects of different heparin prophylaxis dosing strategies in the critically ill patient. Critically ill adult patients who were mechanically ventilated for at least 1 day and had an intensive care unit (ICU) length of stay of at least 2 days were included. Patients received 5000 units of heparin either twice/day or 3 times/day. The primary outcome was development of a new VTE. Key secondary outcomes included clinically important bleeding, thrombocytopenia, and mortality. Patients were propensity matched to control for confounding. Multivariable analysis was conducted for VTE risk factors. Results The study included 30,800 patients from 374 hospitals who were propensity matched by heparin dosage. New VTE occurred in 6.16% of patients treated with 3 times/day heparin versus 6.23% with twice/day heparin (p=0.8). No significant differences in the incidence of pulmonary embolism (0.91% vs 0.8%, p=0.29) or deep vein thrombosis (5.56% vs 5.70% p=0.59) were observed between the two types of heparin dosing. No differences were observed between the two types of heparin dosing in in‐hospital mortality (15.8% vs 15.15%), bleeding (0.23% vs 0.33%), or thrombocytopenia (5.19% vs 5.34%, p>0.08 for all), respectively. Risk factors associated with VTE included intraabdominal and urinary tract infections, loop diuretics, malnutrition, obesity, thrombocytopenia, paralytics, vasopressors, female sex, peripheral vascular disease, sepsis, neutropenia, and end‐stage renal disease. Antiplatelet therapy, heart failure, diabetes, and substance abuse were associated with reduced VTE (p<0.05 for all). Conclusions In critically ill patients, prophylactic dosing of heparin 3 times/day versus twice/day was not associated with differences in new VTE or safety outcomes. Several modifiable VTE risk factors were identified.

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Section: Discussionmentioning

confidence: 81%

Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

et al. 2019

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“…(2015)410 was found as a result of a literature search for papers regarding VTE in sepsis patients. This paper discussed the results of a multicenter prospective study on the incidence of VTE based on venous echocardiography examinations of patients with sepsis or septic shock admitted to the intensive care unit (ICU), and reported that although measures to prevent VTE were taken in all cases, the incidence of VTE was high (42 of 113 cases [37.2%]).…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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“…In addition to the acute complications in sepsis (eg, organ failure, hypotension, thrombosis), septic syndromes are associated with long-term complications, including cognitive dysfunction, debilitation, and significant reductions in health-related quality of life. 3,4 As the risk and incidence of sepsis increase with age, coupled with forecasts of a sustained rise in the age of the population, sepsis will continue to be a substantial public health issue.…”

Section: Introductionmentioning

confidence: 99%

Platelets in infectious disease

Middleton

Rondina

2016

Hematology

Self Cite

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Sepsis is a dynamic, acute, infectious disease syndrome characterized by dysregulated thrombo-inflammatory responses. The high mortality associated with sepsis has been recognized since the earliest clinicians' writings. Despite this, advances in the treatment of sepsis have been more modest. This is limited, in part, by the heterogeneity in the definition, population, presentation, and causal factors of infectious syndromes. Given the persistently high morbidity and mortality associated with sepsis, a better understanding of the dysregulated cellular biology underpinning sepsis is needed. Platelets are small, anucleate cells that have hemostatic, inflammatory, and immune-mediating properties. Platelets are the second most common circulating blood cell, and emerging evidence suggests that platelets serve as sentinel and effector cells during infectious syndromes. Nevertheless, the molecular and functional changes that occur in platelets during sepsis, and their impact on the clinical course of infected patients, remain incompletely understood. In this review, we first highlight the complex and dynamic pathophysiology characteristics of acute, systemic infections and we then discuss established and emerging evidence of the roles of platelets in sepsis. Learning Objectives• Understand the systemic pathophysiology and thromboinflammation characteristic of human infectious disease syndromes • Review the role of platelets in sepsis as modulating host hemostatic, inflammatory, and immune activities

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VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

Abstract: BACKGROUND: Prospective studies on the incidence of VTE during severe sepsis and septic shock remain absent, hindering effi cacy assessments regarding VTE prevention strategies in sepsis.

Cited by 216 publications

References 25 publications

Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Platelets in infectious disease

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