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

2020 ◽  
Vol 8 (2) ◽  
pp. 406
Author(s):  
Viral B. Patel ◽  
Labani M. Ghosh ◽  
Bhalendu Vaishnav
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Risk Stratification ◽  
Central Venous Access ◽  
Venous Access ◽  
P Value ◽  
Central Venous ◽  
Assessment Score ◽  
Vein Thrombosis ◽  
Deep Vein

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.

Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

2021 ◽  
Author(s):  
Miguel García-Boyano ◽  
José Manuel Caballero-Caballero ◽  
Marta García Fernández de Villalta ◽  
Mar Gutiérrez Alvariño ◽  
María Jesús Blanco Bañares ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Access Device ◽  
Vein Thrombosis ◽  
Venous Access Device ◽  
Deep Vein

scholarly journals Derivation and Validation of a Prediction Model for Risk Stratification of Post-Thrombotic Syndrome in Elderly Patients with a First Deep Vein Thrombosis

2018 ◽  
Vol 118 (08) ◽  
pp. 1419-1427 ◽  
Author(s):  
Marie Méan ◽  
Andreas Limacher ◽  
Adriano Alatri ◽  
Drahomir Aujesky ◽  
Lucia Mazzolai
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Risk Stratification ◽  
Prediction Model ◽  
Prediction Rule ◽  
Brier Score ◽  
Risk Category ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Deep Vein

Background Not all patients carry the same risk of developing a post-thrombotic syndrome (PTS), we therefore aimed to derive a prediction rule for risk stratification of PTS in patients with deep vein thrombosis (DVT). Methods Our derivation sample included 276 patients with a first acute symptomatic lower limb DVT enrolled in a prospective cohort. We derived our prediction rule using regression analysis, with the occurrence of PTS within 24 months of a DVT based on the Villalta score as outcome, and 11 candidate variables as predictors. We used bootstrapping methods for internal validation. Results Overall, 161 patients (58.3%) developed a PTS within 24 months of a DVT. Our prediction rule was based on five predictors (age ≥ 75 years, prior varicose vein surgery, multi-level thrombosis, concomitant antiplatelet/non-steroidal anti-inflammatory drug therapy and the number of leg symptoms and signs). Overall, 16.3, 31.2 and 52.5% of patients were classified as low- (score, 0–3), moderate (score, 4–5) and high-risk (score, ≥ 6), for developing a PTS. Within 24 months of the index DVT, 24.4% of the patients in the low-risk category developed a PTS, 38.4% in the moderate and 80.7% in the high-risk category. The prediction model showed good predictive accuracy (area under the curve, 0.77; 95% confidence interval, 0.71–0.82, calibration slope, 0.90 and Brier score, 0.20). Conclusion This easy-to-use clinical prediction rule accurately identifies patients with DVT who are at high risk of developing PTS within 24 months who could potentially benefit from special educational or therapeutic measures to limit the risk of PTS.

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

1996 ◽  
Vol 75 (02) ◽  
pp. 242-245 ◽  
Author(s):  
Marie Magnusson ◽  
Bengt I Eriksson ◽  
Peter Kãlebo ◽  
Ramon Sivertsson
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Screening Method ◽  
Colour Doppler ◽  
Vein Thrombosis ◽  
Colour Doppler Ultrasound ◽  
Asymptomatic Patients ◽  
Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

scholarly journals A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lloyd Roberts ◽  
Tom Rozen ◽  
Deirdre Murphy ◽  
Adam Lawler ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
High Risk ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Major Trauma ◽  
Intraclass Correlation ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

2021 ◽  
pp. 1358863X2199467
Author(s):  
Jean-Eudes Trihan ◽  
Michael Adam ◽  
Sara Jidal ◽  
Isabelle Aichoun ◽  
Sarah Coudray ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Operating Characteristics ◽  
Vein Thrombosis ◽  
Ultrasound Study ◽  
Wells Score ◽  
Deep Vein ◽  
The Impact ◽  
Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

2000 ◽  
Vol 15 (2) ◽  
pp. 71-74 ◽  
Author(s):  
O. Agu ◽  
A. Handa ◽  
G Hamilton ◽  
D. M. Baker
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Teaching Hospital ◽  
Surgical Patients ◽  
Thrombosis Prophylaxis ◽  
High Risk Patients ◽  
Vein Thrombosis ◽  
Dvt Prophylaxis ◽  
Risk Patients ◽  
Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

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