Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies

Abstract

Background The objective of this study was to describe the prevalence, incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients receiving contemporary thrombosis prophylaxis. Methods We conducted a pooled analysis of two prospective cohort studies. The outcomes of interest were in-hospital pulmonary embolism or lower extremity deep vein thrombosis (PE-LDVT), in-hospital nonleg deep vein thrombosis (NLDVT), and 90-day mortality. Multivariable logistic regression analysis was used to evaluate the association between predefined baseline prognostic factors and PE-LDVT or NLDVT. Cox regression analysis was used to evaluate the association between PE-LDVT or NLDVT and 90-day mortality. Results A total of 2208 patients were included. The prevalence of any venous thromboembolism during 3 months before ICU admission was 3.6% (95% CI 2.8–4.4%). Out of 2166 patients, 47 (2.2%; 95% CI 1.6–2.9%) developed PE-LDVT and 38 patients (1.8%; 95% CI 1.2–2.4%) developed NLDVT. Renal replacement therapy (OR 3.5 95% CI 1.4–8.6), respiratory failure (OR 2.0; 95% CI 1.1–3.8), and previous VTE (OR 3.6; 95% CI 1.7–7.7) were associated with PE-LDVT. Central venous catheters (OR 5.4; 95% CI 1.7–17.8) and infection (OR 2.2; 95% CI 1.1–4.3) were associated with NLDVT. Occurrence of PE-LDVT but not NLDVT was associated with increased 90-day mortality (HR 2.7; 95% CI 1.6–4.6, respectively, 0.92; 95% CI 0.41–2.1). Conclusion Thrombotic events are common in critically ill patients, both before and after ICU admittance. Development of PE-LDVT but not NLDVT was associated with increased mortality. Prognostic factors for developing PE-LDVT or NLDVT despite prophylaxis can be identified at ICU admission and may be used to select patients at higher risk in future randomized clinical trials. Trial registration NCT03773939.

Risk Factors for Venous Thromboembolism in Severe COVID-19: A Study-Level Meta-Analysis of 21 Studies

“…In the present meta-analysis that encompasses 5296 ICU patients from 21 observational studies, we identified low –to moderate-certainty evidence for the risk factors for VTE, including the COVID-19 severity (i.e., requirement for mechanical ventilation, use of inotropic drugs, length of hospital stay, and SOFA score at VTE screening) and biological parameters (i.e., D-dimer levels, DIC ISTH criteria, CRP level, troponin T, procalcitonin, thrombocytopenia). Some risk factors previously reported were not confirmed by our analysis, including an older age, female sex, obesity [ 36 , 37 ], and a medical history of VTE or cancer [ 38 , 39 ]. Interestingly, the use of anticoagulants at any dose was not associated with a different risk of thrombosis in the univariate analysis.…”

Prognostic Nomogram for Predicting Lower Extremity Deep Venous Thrombosis in Neurointensive Care Unit Patients: A Prospective Observational Study

“…This study found that in our neurointensive care unit patient cohort, the incidence of lower extremity DVT was 36.4%, which was higher than the incidence in patients after neurosurgery who are not admitted to the neurointensive care unit reported by other studies (1,3). This may be because intensive care unit patients have a higher risk of DVT overall (9)(10)(11). Among the 420 patients included in the primary cohort, the age of patients with lower extremity DVT was significantly higher than those without (P < 0.001).…”

Influence of Early Multidisciplinary Collaboration on Prevention of ICU-Acquired Weakness in Critically Ill Patients

“…Besides, ICU-AW, DVT, PSs, and VAP are also common complications in CIPs [ 22 – 24 ]. The reduction of the incidence of these complications can not only improve the QoL and physical function of CIPs but also facilitate their early rehabilitation.…”