Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors

Cook, Deborah J.; Crowther, Mark; Meade, Maureen O.; Rabbat, Christian G.; Griffith, Lauren; Schiff, David; Geerts, William; Guyatt, Gordon

doi:10.1097/01.ccm.0000171207.95319.b2

Cited by 370 publications

(325 citation statements)

References 42 publications

Supporting

Mentioning

288

Contrasting

Unclassified

Order By: Relevance

“…The incidence of DVT acquired in the ICU may be as high as 10% [512]; the incidence of acquired PE may be 2-4% [513,514]. Patients with sepsis and septic shock are likely at increased risk for this complication.…”

Section: We Suggest Mechanical Vte Prophylaxis When Pharmacologic Vtementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

View full text Add to dashboard Cite

Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

show abstract

Section: We Suggest Mechanical Vte Prophylaxis When Pharmacologic Vtementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Other thrombotic risk factors that may be acquired during the ICU stay include immobilization, pharmacologic paralysis, central venous lines, surgical procedures, sepsis, mechanical ventilation, vasopressor use, and hemodialysis. 22,23 Neither D-dimer levels nor tests of hypercoagulability (activated protein C resistance ratio, Prothrombin 20210A gene mutation, levels of protein C, protein S, or antithrombin, anticardiolipin antibody titer, and lupus anticoagulant) had any predictive value for DVT in critically ill patients. 25 There are only two published randomized trials of thromboprophylaxis in critical care patients in which routine screening with an objective diagnostic test was used to detect DVT.…”

Section: Critical Care Patientsmentioning

confidence: 99%

“…[22][23][24] Some of the patient risk factors that predate the ICU admission include recent surgery, trauma, sepsis, ma-lignancy, immobilization, increased age, heart or respiratory failure, and previous VTE. Other thrombotic risk factors that may be acquired during the ICU stay include immobilization, pharmacologic paralysis, central venous lines, surgical procedures, sepsis, mechanical ventilation, vasopressor use, and hemodialysis.…”

Section: Critical Care Patientsmentioning

confidence: 99%

Prevention of Venous Thromboembolism in High-Risk Patients

Geerts

2006

Hematology

View full text Add to dashboard Cite

The prevention of venous thromboembolism (VTE) in patients recovering from major trauma, spinal cord injury (SCI), or other critical illness is often challenging. These patient groups share a high risk for VTE, they often have at least a temporary high bleeding risk, and there are relatively few thromboprophylaxis trials specific to these populations. A systematic literature review has been conducted to summarize the risks and prevention of VTE in these three groups. It is concluded that routine thromboprophylaxis should be provided to major trauma, SCI and critical care patients based on an individual assessment of their thrombosis and bleeding risks. For patients at high risk for VTE, including those recovering from major trauma and SCI, prophylaxis with a low molecular weight heparin (LMWH) should commence as soon as hemostasis has been demonstrated. For critical care patients at lower thrombosis risk, either LMWH or lowdose heparin is recommended. For those with a very high risk of bleeding, mechanical prophylaxis should be instituted as early as possible and continued until pharmacologic prophylaxis can be initiated. The use of prophylactic inferior vena caval filters is strongly discouraged because their potential benefit has not been shown to outweigh the risks or substantial costs. Implementation of thromboprophylaxis in these patients requires a local commitment to this important patient safety priority as well as a highly functional delivery system, based on the use of pre-printed orders, computer prompts, regular audit and feedback, and ongoing quality improvement efforts.Across the spectrum of hospitalized patients, the rates of venous thromboembolism (VTE) vary substantially.1 Although a large number of patient-specific thrombosis risk factors have been shown to contribute to this variability, the principal factor that determines VTE risk is the patient's primary reason for hospitalization, whether this is a surgical procedure or an acute medical illness. This paper will discuss the risks of VTE in three populations: major trauma, spinal cord injury (SCI) and critical care patients. The reasons for selecting these patient groups are as follows: each is associated with a high risk of VTE; there is often also a temporary high risk of bleeding; and there have been relatively few studies of prophylaxis in each of these groups. Despite the challenges involved in preventing VTE in these patients, recent evidence allows clinicians to provide effective and safe prophylaxis (see Figure 1).

show abstract

“…5 Mechanically ventilated patients have also been identified at higher risk for VTE due to decreased cardiac output particularly in the presence of hypovolemia impaired cardiovascular reflexes and/or venous stasis. 24,25 Information on the subjects as it relates to the status of mechanical ventilator use was not collected or analyzed. Despite these risk factors, no statistically significant difference was noted in the development of VTE between the CHG or non-CHG PICC groups.…”

Section: Venous Thromboembolism (Vte)mentioning

confidence: 99%

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

Storey

Brown

Foley

et al. 2016

American Journal of Infection Control

View full text Add to dashboard Cite

Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors

Abstract: Despite universal thromboprophylaxis, medical-surgical critically ill patients remain at risk for lower extremity deep venous thrombosis. Further research is needed to evaluate the risks and benefits of more intense venous thromboembolism prophylaxis.

Cited by 370 publications

References 42 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Prevention of Venous Thromboembolism in High-Risk Patients

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

Contact Info

Product

Resources

About