Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis

Minet, Clémence; Potton, L.; Bonadona, Agnès; Hamidfar-Roy, Rébecca; Somohano, C. Ara; Lugosi, M.; Cartier, Jean Charles; Ferretti, G.; Schwebel, Carole; Timsit, Jean François

doi:10.1186/s13054-015-1003-9

Cited by 213 publications

(198 citation statements)

References 88 publications

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“…D-dimer is a degradation product of cross-linked fibrin which typically increases with acute VTE [29,30]. According to studies, D-dimer levels increase with various types of non-thrombotic disorders such as atrial fibrillation, acute coronary syndrome, stroke, severe hemorrhagic digestion, infection, disseminated intravascular coagulation and severe renal dysfunction, recent major surgery, bleeding, trauma, and malignancy as well as with age and pregnancy [2,29]. Hence, D-dimer testing has a low specificity in ICU patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…According to studies, D-dimer levels increase with various types of non-thrombotic disorders such as atrial fibrillation, acute coronary syndrome, stroke, severe hemorrhagic digestion, infection, disseminated intravascular coagulation and severe renal dysfunction, recent major surgery, bleeding, trauma, and malignancy as well as with age and pregnancy [2,29]. Hence, D-dimer testing has a low specificity in ICU patients [2]. There were a total of 23 patients with brain lesion (CVA-ICH) and 45 patients with trauma in this study, which can be due to positive D-dimer in the studied patients.…”

Section: Discussionmentioning

confidence: 99%

“…VTE is a common complaint in critically ill patients [2]. These patients are prone to DVT due to factors such as need for surgery, catheter, immobility, and use of sedatives or neuromuscular-blocking drugs [3].…”

Section: Introductionmentioning

confidence: 99%

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Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Moghadam

Asadizaker

Jahani

et al. 2018

Asian J Pharm Clin Res

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Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Moghadam

Asadizaker

Jahani

et al. 2018

Asian J Pharm Clin Res

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“…The clinical manifestations of PE are dependent on the location and size of the obstruction [6]. For example, healthy patients presenting with a small PE may have stable vital signs and be asymptomatic, whereas patients with significant comorbidities may become unstable with even a small PE [8].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Campa¹,

Gantioque²

2018

WJCD

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Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success. The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting. In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035" and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic thrombolysis. This literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035" and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.

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“…Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep venous thrombosis (DVT), remains a major challenge and represents severe complications in the care of critically ill patients . Indeed, intensive care unit (ICU) patients are at a high risk of VTE because they are subject to several general risk factors for VTE (such as immobilization, age, obesity, past history of neoplasm, sepsis, recent surgery, trauma) and ICU‐related risk factors (such as sedation, central venous catheterization, respiratory or heart failure and the use of vasoactive drugs) . In fact, in the ICU, most patients are severely ill requiring sedation and mechanical ventilation (MV) .…”

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases

Bahloul

Regaieg

Dlela

et al. 2019

Clinical Respiratory J

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Purpose to evaluate the current rate of pulmonary embolism (PE) in our medico‐surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. Methods We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one‐year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. Results During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. Conclusion Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk‐factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.

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Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis

Cited by 213 publications

References 88 publications

Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases

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