DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200217

Deep vein thrombosis risk stratification in intensive care unit patients: a pressing need

Viral B. Patel, Labani M. Ghosh, Bhalendu Vaishnav

Abstract


Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.

Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.

Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.

Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU.  SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.


Keywords


Deep vein thrombosis, Prophylaxis, Risk stratification, Venous doppler

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References


Hull R, Delmore T, Genton E, Hirsh J, Gent M, Sackett D, et al. Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med. 1979;301:855-8.

Huisman MV, Büller HR, ten Cate JW, van Royen EA, Vreeken J, Kersten MJ, et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest. 1989;95:498-502.

Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17:259-70.

Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ. 3rd Risk factors for deep vein thrombosis and pulmonary embolism: A population-based case-control study. Arch Intern Med. 2000;160:809-15.

Vijayraghwan KS, Sharma S, Pai VM. DVT in South Indian Population. Ind J Surg. 2001;63:199-201.

Bergqvist D, Lindblad B. Embolism verified at autopsy : An analysis of 1274 surgical patients. Br J Surg. 1988;72:105-8.

Pinjala RK, Agarwal MB, Turpie AGG. A Characterisation of patients with symptomatic DVT in India; for PRO VE investigators. J Thromb Haemost. 2005;3:1043.

Bhan S, Dhaon BK, Gulati Y, Aggawal S. DVT prophylaxis: A multicentric study. Indian J Orphtop. 2004;38:178-82.

Lee AD, Stephen E, Agarwal S, Premkumar P. Venous – Thromboembolism in India. Eur J Vasc Endovasc Surg. 2009;37:482-5.

Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997 Dec 20;350(9094):1795-8.

Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008 Jun 1;133(6):381S-453S.

Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008 Feb 2;371(9610):387-94.

Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008 Jun 1;133(6):454S-545S.