Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial

Abstract

Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.

Prevalence and Clinical Burden of Venous Thromboembolic Events (VTEs) in Contemporary Total Knee Arthroplasties (TKAs) in US Hospitals

“…While newer prophylactic measures have reduced VTE risk compared to previous methods, they have not necessarily improved overall survival rates, prompting debates around the need for individualized prophylaxis strategies [8]. Furthermore, studies suggesting that asymptomatic deep vein thromboses (DVTs) may lead to clinical complications in certain patients highlight the potential value of ultrasound screening for DVT in select cases [9].However, the cost-effectiveness and efficacy of such screening remain uncertain, emphasizing the importance of identifying which patients are at highest risk. The question of who constitutes a high-risk patient is therefore crucial in optimizing VTE prevention strategies and clinical outcomes.…”

“…The ability to predict which patients are more susceptible to VTE is pivotal in advancing effective preventative strategies. It is noteworthy that, despite diligent efforts to implement prophylactic measures, instances of VTE may still manifest [5][6][7][8][9]. The scientific community has witnessed a plethora of studies aimed at identifying predictive factors for VTE [5][6][7][8][9].…”

“…It is noteworthy that, despite diligent efforts to implement prophylactic measures, instances of VTE may still manifest [5][6][7][8][9]. The scientific community has witnessed a plethora of studies aimed at identifying predictive factors for VTE [5][6][7][8][9]. However, ongoing debates persist surrounding the most efficacious strategies.…”