Ultrasound-guided “Low Approach” Femoral Vein Catheterization in Critical Care Patients Results in High Incidence of Deep Vein Thrombosis

Abstract Background Approximately 13–31% of medical critical care patients develop deep vein thrombosis (DVT). However, there are very few reports regarding the incidence of DVT among Asian patients without routine prophylaxis. The objectives of this study were to assess the prevalence and incidence proportion of proximal DVT in Thai medical critical care patients not receiving thrombosis prophylaxis. Methods We conducted a prospective cohort study in medical critical care patients admitted to Siriraj Hospital, Thailand between November 2008 and November 2009. Patients were screened for proximal DVT by duplex ultrasonography performed 48 hours, 7, 14 and 28 days after admisson. Primary outcomes were prevalence and incidence proportion of DVT. Factors associated with the development of proximal DVT were evaluated by multivariate analysis. Results Of the 158 patients enrolled in the study, 25 had proximal DVT (15.8%). Nine patients (5.7%) had DVT on the first test at 48 hours, while 10 (6.3%), 2 (1.3%) and 4 (2.5%) patients had developed DVT on days 7, 14, and 28, respectively. Thus, the prevalence at the beginning of the study was 5.7% (95%CI 2.6–10.5) and the incidence proportion was 10.1% (95%CI 5.9–15.9). The multivariate analysis showed that age (odds ratio [OR] per 1-year increase was 1.04, 95% confidence interval [CI] 1.01–1.07), female gender (OR 4.05, 95%CI 1.51–12.03), femoral venous catheter (OR 11.18, 95%CI 3.19–44.83), and the absence of platelet transfusion (OR 0.07, 95%CI 0.003–0.43) were associated with the development of proximal DVT. Patients with proximal DVT had a longer hospital length of stay (22 days [IQR 11–60] vs 14 days [7–23], p = 0.03) and spent more time on mechanical ventilation (10 days (3.3–57) vs 6 days (3–12), p = 0.053) than patients without DVT. Patient mortality was not affected by the presence of DVT (52% vs 38.3%, p = 0.29). Conclusions Routine thromboprophylaxis is not used in our institution and the prevalence and incidence proportion of proximal DVT in medical critical care patients were both substantial. Patients with older age, female gender, an intravenous femoral catheter, and the absence of platelet transfusion all had a higher chance of developing proximal DVT.

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Chronic lower extremity deep vein thrombosis associated with femoral vein compression by a lipoma.

American Journal of Roentgenology ◽

10.2214/ajr.172.6.10350325 ◽

1999 ◽

Vol 172 (6) ◽

pp. 1697-1698 ◽

Cited By ~ 5

Author(s):

P S Brady ◽

L D Spence

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Femoral Vein ◽

Vein Thrombosis ◽

Deep Vein

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A murine model of deep vein thrombosis Characterization and validation in transgenic mice

Thrombosis and Haemostasis ◽

10.1160/th05-03-0170 ◽

2005 ◽

Vol 94 (09) ◽

pp. 498-503 ◽

Cited By ~ 25

Author(s):

Linda Szema ◽

Chao-Ying Chen ◽

Jeffrey P. Schwab ◽

Gregory Schmeling ◽

Brian C. Cooley

Keyword(s):

Deep Vein Thrombosis ◽

Murine Model ◽

Femoral Vein ◽

Previous History ◽

Bed Rest ◽

Major Surgery ◽

Vein Thrombosis ◽

Transgenic Lines ◽

History Of ◽

Deep Vein

SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.

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Comparative Study of Deep Vein Thrombosis Recanalization Using Doppler Ultrasound in Different Post-Treatment Intervals in Traumatic Patients

ACTA MEDICA IRANICA ◽

10.18502/acta.v60i1.8324 ◽

2022 ◽

Author(s):

Nazanin Farshchian ◽

Negin Farshchian ◽

Parisa Bahrami Kamangar

Keyword(s):

Deep Vein Thrombosis ◽

Doppler Ultrasound ◽

Statistical Tests ◽

Significance Level ◽

Sonographic Diagnosis ◽

Vein Thrombosis ◽

Significant Difference ◽

High Incidence ◽

Deep Vein ◽

Comparative Examination

Deep vein thrombosis (DVT) is a prevalent vascular disease characterized by pelvic and limb deep vein thrombophlebitis, and it has a high incidence in traumatic patients. Contrary to older studies, recent research has reported that recanalization in DVT is not a slow process. The present study aimed at the comparative examination of DVT recanalization with Doppler ultrasound in different intervals following treatment with heparin or enoxaparin. This prospective study was conducted on all traumatic patients hospitalized in Imam Reza Hospital of Kermanshah, Iran, with the clinical and sonographic diagnosis of DVT in limb veins. Doppler ultrasound was performed two weeks, one month, and three months following treatment in order to examine recanalization. Data were analyzed using statistical tests in SPSS16 at the significance level of <0.05. Based on Doppler ultrasound, a significant difference was found between the degree of recanalization in patients aged <45 years and those aged >45 years, between male and female patients, and between different DVT locations (P<0.05). After three months of treatment with heparin and enoxaparin, the degree of recanalization was increased in DVT. Moreover, it was found that Doppler ultrasound is a useful tool for the diagnosis of recanalization in patients with DVT.

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TCTAP C-223 Catheter-directed Thrombolysis, Iliac and Common Femoral Vein Stenting in May-thurner Syndrome with Refractory Deep Vein Thrombosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.03.438 ◽

2016 ◽

Vol 67 (16) ◽

pp. S373-S374

Author(s):

Chiung-Ray Lu ◽

Ke Wei Chen

Keyword(s):

Deep Vein Thrombosis ◽

Femoral Vein ◽

Common Femoral Vein ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Abnormal Blood Yield Stress as an Aetiological Factor in Postoperative Deep Venous Thrombosis

10.1055/s-0039-1689540 ◽

1975 ◽

Author(s):

W. V. Humphreys ◽

A. Walker ◽

D. Charlesworth

Keyword(s):

Deep Vein Thrombosis ◽

Yield Stress ◽

Malignant Disease ◽

Aetiological Factor ◽

Venous Stasis ◽

Vein Thrombosis ◽

High Incidence ◽

Deep Vein ◽

Postoperative Deep Venous Thrombosis ◽

Low Shear

An elevated blood viscosity could lead to increased venous stasis and a higher incidence of post-operative deep vein thrombosis. Immediately preoperatively we have measured, using a Contraves low shear 2 viscometer, blood yield stress and viscosity at high and low shear rate in 28 general surgical patients. These patients were then screened by the standard I125 fibrinogen technique to detect the development of deep vein thrombosis post-operatively.13 patients developed a deep vein thrombosis. These patients had a significantly higher blood yield stress, corrected to a standard haemoerit of 45%, than the others (P < 0.01 students t). All other viscosity parameters were normal in these patients. Patients with malignant disease had a very high incidence of thrombosis (90%: 30%) and significantly higher yield stress values (mean 0.26 dynes/cm2: mean 0.194 dynes/cm2, P < 0.0005 students t) compared to patients with benign disease.We conclude that a high blood yield stress could be an important aetiological factor in thrombosis and the high values obtained in patients with malignant disease could partly explain the high incidence in these patients.

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Advantages of a Sequential Compression Device in Prevention of Deep Vein Thrombosis

10.1055/s-0039-1684785 ◽

1979 ◽

Author(s):

A.N. Nicolaides ◽

J. Fernandas ◽

A.V. Pollock

Keyword(s):

Deep Vein Thrombosis ◽

Femoral Vein ◽

Test Group ◽

Heparin Group ◽

Similar Time ◽

Vein Thrombosis ◽

Compression Device ◽

Fibrinogen Test ◽

Group B ◽

Deep Vein

A sequential compression device (SCD) (6 chambers) compressing the ankle, calf end thigh sequentially at 35, 30 and 20 mm Hg for 12 seconds in every minute produced a 240% increase in peak velocity in the femoral vein. A non-sequential device (NSD) inflated to 25 mm Hg with a similar time cycle produced only an 180% increase in blood velocity.The two devices were tested clinically; 250 surgical patients were randomised to 3 groups scanned with the 125 I-fibrinogen test. Group A: 7 days subcutaneous heparin. Group B: NSD for 24 hours. Group C: SCD for 24 hours. The SCD was found to be as effective as heparin during the period it was used and more effective than NSD in preventing deep vein thrombosis proximal to the calf.

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Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

Critical Care Research and Practice ◽

10.1155/2012/489135 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Michael Blaivas ◽

Konstantinos Stefanidis ◽

Serafim Nanas ◽

John Poularas ◽

Mitchell Wachtel ◽

...

Keyword(s):

Risk Factors ◽

Critical Care ◽

Upper Extremity ◽

Strong Predictor ◽

Venous Catheter ◽

Acute Thrombosis ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Deep Vein ◽

Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

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