P Hilbert1, K Zur Nieden, R Stuttmann. 1. Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, BG Kliniken Bergmannstrost, Halle. Peter.Hilbert@bergmannstrost.com
Abstract
BACKGROUND: Clinically unrecognized thrombosis with the danger of a pulmonary embolism represents an underestimated problem in surgical ICU patients. In patients undergoing total hip replacement for instance, over 30% develop a clinically inapparent form of thrombosis, despite initial thrombosis prophylaxis. We tried to recognize clinically inapparent thrombosis in long-term intensive care patients using D-dimer screening and ultrasound imaging. METHODS: All surgical long-term ICU patients received intravenous heparin 5-10 IU/kg body weight and a D-dimer was assay was carried out every 2 days. If the D-dimer level surpassed 2 mg/l, ultrasound imaging of the veins in the legs, pelvis, arms and neck was performed. RESULTS: Included in the study were 50 patients and D-dimer levels above 2 mg/l were detected in 38%. A thrombosis was proven in 63% of the patients with D-dimer values above 2 mg/l and 50% of the thrombosis were detected in the arm and neck veins very often associated with intravenous catheters. CONCLUSION: Routine D-dimer screening and specific use of ultrasound imaging appears to be a valuable method to verify clinically inapparent thromboses in surgical ICU patients.
BACKGROUND: Clinically unrecognized thrombosis with the danger of a pulmonary embolism represents an underestimated problem in surgical ICU patients. In patients undergoing total hip replacement for instance, over 30% develop a clinically inapparent form of thrombosis, despite initial thrombosis prophylaxis. We tried to recognize clinically inapparent thrombosis in long-term intensive care patients using D-dimer screening and ultrasound imaging. METHODS: All surgical long-term ICU patients received intravenous heparin 5-10 IU/kg body weight and a D-dimer was assay was carried out every 2 days. If the D-dimer level surpassed 2 mg/l, ultrasound imaging of the veins in the legs, pelvis, arms and neck was performed. RESULTS: Included in the study were 50 patients and D-dimer levels above 2 mg/l were detected in 38%. A thrombosis was proven in 63% of the patients with D-dimer values above 2 mg/l and 50% of the thrombosis were detected in the arm and neck veins very often associated with intravenous catheters. CONCLUSION: Routine D-dimer screening and specific use of ultrasound imaging appears to be a valuable method to verify clinically inapparent thromboses in surgical ICU patients.
Authors: P F Leyvraz; J Richard; F Bachmann; G Van Melle; J M Treyvaud; J J Livio; G Candardjis Journal: N Engl J Med Date: 1983-10-20 Impact factor: 91.245
Authors: Philip S Wells; David R Anderson; Marc Rodger; Melissa Forgie; Clive Kearon; Jonathan Dreyer; George Kovacs; Michael Mitchell; Bernard Lewandowski; Michael J Kovacs Journal: N Engl J Med Date: 2003-09-25 Impact factor: 91.245