Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography

Introduction: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. Methods: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Results: Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence ( P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis ( P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay ( P = .35) or mortality ( P = .34). Conclusions: Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

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Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia

Blood ◽

10.1182/blood-2002-05-1448 ◽

2003 ◽

Vol 101 (8) ◽

pp. 3049-3051 ◽

Cited By ~ 114

Author(s):

Aaron P. Hong ◽

Deborah J. Cook ◽

Christopher S. Sigouin ◽

Theodore E. Warkentin

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Orthopedic Surgery ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Deep Vein ◽

Limb Deep Vein Thrombosis

Abstract Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT—either with or without central venous catheter (CVC) use—is unknown. We therefore studied 260 patients with antibody-positive HIT to determine the influence of CVC use on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). Compared with the control populations, both upper- and lower-extremity DVTs were found to be associated with HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (14 of 145 [9.7%]) versus none of 115 (0%) patients without a CVC (P = .000 35). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.

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Deep vein thrombosis associated with central venous catheters - a review

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2005.01398.x ◽

2005 ◽

Vol 3 (11) ◽

pp. 2409-2419 ◽

Cited By ~ 97

Author(s):

C. J. ROODEN ◽

M. E. T. TESSELAAR ◽

S. OSANTO ◽

F. R. ROSENDAAL ◽

M. V. HUISMAN

Keyword(s):

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

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Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters

VASA ◽

10.1024/0301-1526/a000217 ◽

2012 ◽

Vol 41 (5) ◽

pp. 319-332 ◽

Cited By ~ 16

Author(s):

Linnemann ◽

Lindhoff-Last

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Vein Thrombosis ◽

Palliative Care Setting ◽

Thrombotic Complications ◽

Randomised Controlled ◽

Deep Vein

An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.

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Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

Journal of the Association for Vascular Access ◽

10.2309/java-d-20-00012 ◽

2020 ◽

Vol 25 (3) ◽

pp. 45-55

Author(s):

Sandeep Tripathi ◽

Kimberly Burkiewicz ◽

Jonathan A. Gehlbach ◽

Yanzhi Wang ◽

Michele Astle

Keyword(s):

Deep Vein Thrombosis ◽

Central Venous Catheter ◽

Ultrasound Guidance ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Retrospective Case ◽

Vein Thrombosis ◽

Deep Vein ◽

Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

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Risk Factors for Central Venous Line-Related Deep Vein Thrombosis and Occlusions in the Israeli Pediatric Oncology Registry.

Blood ◽

10.1182/blood.v112.11.1814.1814 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1814-1814

Author(s):

Shoshana Revel-Vilk ◽

Joanne Yacobovich ◽

Hannah Tamary ◽

Gal Goldstein ◽

Isaac Yaniv ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Family History ◽

Prospective Study ◽

Central Venous ◽

Vein Thrombosis ◽

Thrombophilia Screening ◽

History Of ◽

Thrombotic Complications ◽

Deep Vein

Abstract The use of central venous lines (CVLs) has greatly improved the quality of care in children with cancer, yet these catheters may cause serious mechanical, infectious and thrombotic complications, both deep vein thrombosis (DVT) and catheter occlusion. The aim of this prospective study is to ascertain the incidence of thrombotic complications and their risk factors. A registry was started in June 2006 for all children undergoing CVL insertion for treatment of cancer in the three largest pediatric cancer centers in Israel. After informed consent was signed, a registration form, that included questions regarding demographic-, clinical- and CVL-related data, and family history of thrombosis, was completed. Blood samples for baseline thrombophilia work-up, i.e. protein C, protein S, anti-thrombin, APCR, Factor V Leiden, Prothrombin gene mutation and MTHFR, were collected with separate consent. The following events were reported to the registry: immediate post insertion complications, venous thrombosis confirmed by imaging, occlusion of the CVL, i.e. inability to infuse and/or withdraw blood, requiring medical or surgical intervention, and CVL infections. The maintenance of CVLs and management of CVL occlusion and infection remained in accordance with institutional protocols. Responsible oncologists decided whether a dysfunctional or an infected CVL was to be removed or replaced, and whether radiographic evaluation for thrombotic complications was indicated. Patients were enrolled until December 2007, and data analysis was completed in June 2008. A total of 414 CVLs, i.e. peripherally inserted central catheters (PICCs) (45%), Hickman catheters (25%) and Port-a-Caths (30%), were inserted into 262 children for a total of 71,241 catheter-days. Fourteen events of venous thrombosis occurred in 13 children (4.9%, 95% confidence interval (CI) 2.6% to 8.3%), including 10 events of CVL-related DVT. The occurrence of CVL-related DVT was significantly higher for PICCs, 4.5%, compared to other types of CVLs, 0.9% (p=0.02, odds ratio (OR) 5.4 (95% CI 1.13 to 25.8)). CVL-related DVT was not associated with age at diagnosis, side of insertion (right vs. left), vessel cannulated, type of cancer (acute lymphoblastic leukemia vs. others), ethnic origin or family history of thrombosis. Occlusion of the CVL occurred at least once in 90 children (34%, 95% CI 29% to 40%). Children with family history of thrombosis were more likely to have CVL occlusion, 62.5%, compared to children without family history of thrombosis, 30.4% (P=0.01, OR 3.8 (95% CI 1.3 to 10.8)). Occlusion was reported in 102 CVLs (24%, 95% CI 20% to 28%). The occurrence of occlusion was higher for Port-a-Caths, 42%, and Hickman catheters, 35%, compared to PICCs, 23% (P<0.01, OR 6.64 (95% CI 2.98 to 14.8) and 4.62 (95% CI 1.84 to 11.6), respectively). CVL-related DVT was not associated with occlusion. Until now, thrombophilia screening has been completed in 85 children (32%), 21 of whom had a positive screen (25%, 95% CI 16% to 35%). A positive thrombophilia screen was found more frequently in children of Arabic origin, 43%, compared to children of Jewish origin, 13% (P=0.006), but was not associated with CVL-related DVT or occlusion. Also, in a subgroup analysis of the children with thrombophilia testing (n=85), children with a family history of thrombosis were more likely to have occlusion compared to children without a family history of thrombosis, 100% vs. 37%, respectively (P=0.01, Bonferroni post-oc correction). Our prospective study shows that insertion of PICCs significantly increases the risk for symptomatic CVL-related thrombosis; other risk factors were not found to be significant. The lower rate of PICC occlusions might be explained by their use for shorter time periods. Interestingly, a positive family history of thrombosis rather than a positive thrombophilia screen was found to be a risk factor for CVL occlusion; perhaps the standard thrombophilia screening is not sensitive enough to detect inherited risk of thrombosis associated with CVLs. The long-term effect of CVL occlusion as a predictor for under-diagnosed CVL-related thrombosis will be determined by following our cohort for development of post-thrombotic syndrome.

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Risk Factors Associated With Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients With Peripherally Inserted Central Venous Catheters

Journal of Infusion Nursing ◽

10.1097/nan.0000000000000037 ◽

2014 ◽

Vol 37 (3) ◽

pp. 187-196 ◽

Cited By ~ 14

Author(s):

Bonnie J. Clemence ◽

Rhonda E. Maneval

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Catheters ◽

Central Venous ◽

Factors Associated ◽

Vein Thrombosis ◽

Deep Vein

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Upper Extremity Deep Vein Thrombosis Central Venous Catheters-Related and Pulmonary Embolism After Cardiac Surgery

CHEST Journal ◽

10.1378/chest.1834520 ◽

2014 ◽

Vol 145 (3) ◽

pp. 527A

Author(s):

Cleante Scarduelli ◽

Redenta Ghirardi ◽

Ornella Tortelli ◽

Rino Frizzelli ◽

Fabia Mascaro ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Surgery ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Catheters ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

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Diagnosis and management of upper extremity deep-vein thrombosis in adults

Thrombosis and Haemostasis ◽

10.1160/th12-05-0352 ◽

2012 ◽

Vol 108 (12) ◽

pp. 1097-1108 ◽

Cited By ~ 66

Author(s):

Jonathan D. Grant ◽

Scott Woller ◽

Edward Lee ◽

Stephen Kee ◽

David Liu ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Catheters ◽

Careful Selection ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein ◽

Central Catheters ◽

Selection Of Patients ◽

Selection Of

SummaryUpper extremity deep-vein thrombosis (UEDVT) is common and can cause important complications, including pulmonary embolism and post-thrombotic syndrome. An increase in the use of central venous catheters, particularly peripherally inserted central catheters has been associated with an increasing rate of disease. Accurate diagnosis is essential to guide management, but there are limitations to the available evidence for available diagnostic tests. Anticoagulation is the mainstay of therapy, but interventional treatments may be considered in select situations. The risk of UEDVT may be reduced by more careful selection of patients who receive central venous catheters and by use of smaller catheters. Herein we review the diagnosis, management and prevention of UEDVT. Due to paucity of research, some principles are drawn from studies of lower extremity DVT. We present a practical approach to diagnosing the patient with suspected deep-vein thrombosis of the upper extremity.

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