Clinically important deep vein thrombosis in the intensive care unit: a survey of intensivists

Abstract

IntroductionOutside the intensive care unit (ICU), clinically important deep vein thrombosis (DVT) is usually defined as a symptomatic event that leads to objective radiologic confirmation and subsequent treatment. The objective of the present survey is to identify the patient factors and radiologic features of lower limb DVT that intensivists consider more or less likely to make a DVT clinically important in ICU patients.MethodsOur definition of clinically important DVT was a DVT likely to result in short-term or long-term morbidity or mortality if left untreated, as opposed to a DVT that is unlikely to have important consequences. We asked respondents to indicate the likelihood that patient factors and ultrasonographic features make a DVT clinically important using a five-point scale (from 1 = much less likely to 5 = much more likely).ResultsOf the 71 Canadian intensivists who responded, 70 (99%) rated three patient factors as most likely to make a DVT clinically important: clinical suspicion of pulmonary embolism (mean score 4.6), acute or chronic cardiopulmonary morbidity that might limit a patient's ability to tolerate pulmonary embolism (score 4.5), and leg symptoms (score 4.2). Of the ultrasound features, proximal (score 4.7), large (score 4.2), and totally occlusive (score 3.9) thrombi were considered the three most important.ConclusionWhen labeling a DVT as clinically important, intensivists rely on different patient specific factors and thrombus characteristics than are used to assess the clinical importance of DVT outside the ICU. The clinical importance of DVT is influenced by unique factors such as cardiopulmonary reserve among mechanically ventilated patients.

Survey of pharmacologic thromboprophylaxis in critically ill children*

“…Observational studies have identified risk factors for DVT (4, 7–10) while our survey indicates factors considered important by practitioners. Other surveys have also reported patient factors and radiologic features that make VTE clinically significant (39, 42). Before conducting a randomized trial of thromboprophylaxis in children, it is essential to perform a prospective multicenter observational study to examine the burden of illness of DVT.…”

An evaluation of practice pattern for venous thromboembolism prevention in Lebanese hospitals

“…In addition, co-morbidity conditions added points to the risk score, resulting in the high-risk category. The analysis in this study focused on ICU versus non-ICU patients [1,9,[48][49][50][51][52] because specific guidelines for the ICU population are established [9,[53][54][55][56][57][58][59][60][61][62]. In the ICU group, two-thirds of the patients received appropriate prophylaxis.…”

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

“…Clinically signifi cant VTE was defi ned as PE, proximal symptomatic or asymptomatic DVT, and symptomatic distal DVT. 9,14,15 Decisions on VTE treatment were left to the discretion of the patient's primary team.…”

“…Prior, well-conducted studies were performed in more heterogeneous groups of critically ill patients that included surgical patients. 1,[7][8][9][10] Sepsis is characterized by pathophysiologic processes distinct in many ways from patients in trauma, surgical, neurologic, and cardiology ICUs. Th is absence of data hinders assessments of the effectiveness of guideline-recommended VTE prophylaxis in severe sepsis and septic shock and limits advances in the prevention of VTE among these patients.…”