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Acta Anaesthesiol Scand. 2019 Jan 8. doi: 10.1111/aas.13316. [Epub ahead of print]

Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome.

Author information

1
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
2
Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
3
Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
4
Department of Research and Development, Oslo University Hospital, Oslo, Norway.
5
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
6
Department of Radiology, Oslo University Hospital, Oslo, Norway.
7
Department of Haematology, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients.

METHODS:

Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason.

RESULTS:

Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58-0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72).

CONCLUSION:

Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.

KEYWORDS:

critical illness; pulmonary embolism; venous thromboembolism; venous thrombosis

PMID:
30623406
DOI:
10.1111/aas.13316

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