Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters

Druar, Nicholas M.; Vosburg, R. Wesley; Cahan, Mitchell A.

doi:10.1111/cob.12526

Cited by 3 publications

(3 citation statements)

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“…We also found an association between obesity and longer catheter dwell time. Interestingly, this factor has been described in the literature as a risk factor for catheter colonization and CRI [ 31 , 32 ], as well as for DVT [ 33 , 34 ]. Strategies to prevent catheter-related intravascular complications could thus be particularly beneficial in these patients.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

Iachkine

Buetti

Grooth

et al. 2023

Ann. Intensive Care

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Background The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications. Methods We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients). Results The analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40–59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66–0.72] in the training cohort and 0.64, 95% CI [0.61–0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort. Conclusion The CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score. Trials Registration NCT01479153, NCT01629550, NCT01189682

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Section: Discussionmentioning

confidence: 99%

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

Iachkine

Buetti

Grooth

et al. 2023

Ann. Intensive Care

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“…11-13 Recent literature suggests that the incidence of UE DVT may be higher in patients who are overweight, have cancer, or have recently had a peripherally inserted central catheter (PICC line) inserted to deliver life-saving medications to a patient. 14-16 Interestingly, UE DVT is also possible in younger throwing athletes due to interstitial trauma from the repetitive forces of throwing during baseball that resulted in an effort thrombosis. 17…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] Recent literature suggests that the incidence of UE DVT may be higher in patients who are overweight, have cancer, or have recently had a peripherally inserted central catheter (PICC line) inserted to deliver life-saving medications to a patient. [14][15][16] Interestingly, UE DVT is also possible in younger throwing athletes due to interstitial trauma from the repetitive forces of throwing during baseball that resulted in an effort thrombosis. 17 An original study from Riddle et al 18 found that care of outpatients who were at risk for PDVT could potentially be improved by use of the clinical decision rules developed by Wells et al, 19 although more study was warranted.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopaedic and Sports Academies

Manske,

Heick,

Young

2024

Cardiopulm Phys Ther J

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PURPOSE: Venous thromboembolism can present as either a deep vein thrombosis (DVT) or a pulmonary embolism. The purpose of this study was to determine if there was a difference in physical therapists' estimation of the probability of a patient having a DVT in patient vignettes as compared with the modified Wells criteria prediction. METHODS: Members of the American Academy of Orthopaedics, Academy of Orthopaedic Physical Therapists (AOPT), and American Academy of Sports Physical Therapy (AASPT) completed patient vignettes. Descriptive statistics were calculated, and sign tests assessed for differences between responses of the presence of DVT (likely or unlikely) and whether referral was necessary. RESULTS: Six hundred and seventy consented, and 521 completed the survey of 24,028 members from the AOPT and AASPT. In total, 7.2% did not feel competent to screen for DVT. Descriptive statistics revealed difficulty in determining whether a DVT was likely or unlikely in 4/5 vignettes as compared with the modified Wells criteria, with only vignette 2 having 95.9% correctly answering as DVT being unlikely. In the other 4 vignettes, approximately 60% to 70% of respondents estimated DVT to be likely, despite 2 of these being unlikely. Across the vignettes, between 2.3% and 19.2% more respondents chose to refer when they determined if a DVT was likely. Across vignettes, statistically significant differences between DVT being likely or unlikely and decision to refer were present. Respondents consistently chose to refer even when a DVT was unlikely (P < .001 for vignettes 1, 3–5. P = .038 for vignette 2). CONCLUSIONS: Venous thromboembolisms are potentially life-threatening conditions seen by physical therapists. Members of the AOPT and AASPT have difficulty in determining the presence or absence of DVT in clinical case vignettes, with some demonstrating a conservative management decision to refer despite low probability of DVT. Efforts to educate members should be considered to improve the understanding of DVT assessment. Clinical Pearls: Members of the AOPT and AASPT appear to have difficulty in determining the presence of a DVT in clinical patient vignettes. Respondents chose to refer patients perhaps with conservative caution. Efforts to educate therapists should be considered to improve the understanding of DVT assessment.

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Venous thrombosis and obesity: from clinical needs to therapeutic challenges

La Rosa,

Montecucco,

Liberale

et al. 2024

Intern Emerg Med

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Weight bias and stigma have limited the awareness of the systemic consequences related to obesity. As the narrative evolves, obesity is emerging as a driver and enhancer of many pathological conditions. Among these, the risk of venous thromboembolism (VTE) is a critical concern linked to obesity, ranking as the third most common cardiovascular condition. Obesity is recognized as a multifactorial risk factor for VTE, influenced by genetic, demographic, behavioral, and socio-economic conditions. Despite established links, the exact incidence of obesity related VTE in the general population remains largely unknown. The complexity of distinguishing between provoked and unprovoked VTE, coupled with gaps in obesity definition and assessment still complicates a tailored risk assessment of VTE risk. Obesity reactivity, hypercoagulability, and endothelial dysfunction are driven by the so-called ‘adiposopathy’. This state of chronic inflammation and metabolic disturbance amplifies thrombin generation and alters endothelial function, promoting a pro-thrombotic environment. Additionally, the inflammation-induced clot formation—also referred to as ‘immunothrombosis’ further exacerbates VTE risk in people living with obesity. Furthermore, current evidence highlights significant gaps in the management of obesity related VTE, particularly concerning prophylaxis and treatment efficacy of anticoagulants in people living with obesity. This review underscores the need for tailored therapeutic approaches and well-designed clinical trials to address the unique challenges posed by obesity in VTE prevention and management. Advanced research and innovative strategies are imperative to improve outcomes and reduce the burden of VTE in people living with obesity.

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Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters

Cited by 3 publications

References 40 publications

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopaedic and Sports Academies

Venous thrombosis and obesity: from clinical needs to therapeutic challenges

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