P E Marik1, L Andrews, B Maini. 1. Department of Critical Care Medicine, St. Vincent Hospital, Worcester, MA 01604, USA. pmarik@ultranet.com
Abstract
STUDY OBJECTIVE: To determine the incidence, clinical presentation, and risk factors of deep venous thrombosis (DVT) in a high-risk group of ICU patients receiving DVT prophylaxis. DESIGN: A prospective cohort study. SETTING: Two ICUs of a university-affiliated teaching hospital. PATIENTS: Patients admitted to the ICUs within 48 h of hospitalization and who had an ICU stay of > or = 4 days underwent venous duplex scans. INTERVENTIONS: None. RESULTS: One hundred two patients were studied. Ninety-four (92%) patients received DVT prophylaxis. Twelve patients (12%) were documented to have DVT by venous duplex scans. There was proximal clot extension in eight of these patients, four of whom had high-probability ventilation/perfusion scans. Of the 56 patients without signs or symptoms of DVT, only two (3.6%) had abnormal scans. Leg swelling was present in 11 patients, six of whom had DVT (p = 0.004). One of 11 patients with unexplained fever had an abnormal scan. Five of the 26 patients (19%) receiving pneumatic compression developed DVT compared with five of 68 patients (7.4%) receiving subcutaneous heparin (not significant). No specific factor was identified that increased the risk of DVT. CONCLUSION: In this study, the incidence of DVT in a group of high-risk ICU patients receiving DVT prophylaxis was 12%. Since scans in patients without signs or symptoms suggestive of DVT were abnormal in only 3.6% of patients, venous scans should be performed only in patients with features suggestive of DVT or pulmonary embolism.
STUDY OBJECTIVE: To determine the incidence, clinical presentation, and risk factors of deep venous thrombosis (DVT) in a high-risk group of ICU patients receiving DVT prophylaxis. DESIGN: A prospective cohort study. SETTING: Two ICUs of a university-affiliated teaching hospital. PATIENTS: Patients admitted to the ICUs within 48 h of hospitalization and who had an ICU stay of > or = 4 days underwent venous duplex scans. INTERVENTIONS: None. RESULTS: One hundred two patients were studied. Ninety-four (92%) patients received DVT prophylaxis. Twelve patients (12%) were documented to have DVT by venous duplex scans. There was proximal clot extension in eight of these patients, four of whom had high-probability ventilation/perfusion scans. Of the 56 patients without signs or symptoms of DVT, only two (3.6%) had abnormal scans. Leg swelling was present in 11 patients, six of whom had DVT (p = 0.004). One of 11 patients with unexplained fever had an abnormal scan. Five of the 26 patients (19%) receiving pneumatic compression developed DVT compared with five of 68 patients (7.4%) receiving subcutaneous heparin (not significant). No specific factor was identified that increased the risk of DVT. CONCLUSION: In this study, the incidence of DVT in a group of high-risk ICU patients receiving DVT prophylaxis was 12%. Since scans in patients without signs or symptoms suggestive of DVT were abnormal in only 3.6% of patients, venous scans should be performed only in patients with features suggestive of DVT or pulmonary embolism.
Authors: Ana T Rocha; Edison F Paiva; Arnaldo Lichtenstein; Rodolfo Milani; Cyrillo Filho Cavalheiro; Francisco H Maffei Journal: Vasc Health Risk Manag Date: 2007
Authors: David Kaplan; T Charles Casper; C Gregory Elliott; Shaohua Men; Robert C Pendleton; Larry W Kraiss; Andrew S Weyrich; Colin K Grissom; Guy A Zimmerman; Matthew T Rondina Journal: Chest Date: 2015-11 Impact factor: 9.410