Prevalence and incidence of proximal deep vein thrombosis in critically ill patients

Introduction

The epidemiology of DVT in critically ill medical patients has not been studied in Thailand. The aim of this study was to assess the prevalence and incidence rate of proximal DVT in these patients and to determine the factors associated with the development of this condition.

Methods

A single-center, prospective observational study was performed in critically ill medical patients who developed sepsis or new organ failure requiring organ support. DVT was detected by ultrasonography with color Doppler imaging performed within 48 hours after the patients met the inclusion criteria, and serial studies at days 7, 14 and 28 (or earlier if clinically indicated) were carried out.

Results

Of the 170 patients, 87 were male (51.2%). The mean age was 59.95 years (range 18 to 94), and the mean APACHE II score was 21.34 (range 4 to 42). Acute respiratory failure and sepsis were the leading diagnoses. Prevalence and incidence of proximal DVT were 14.1% (95% CI 9.6 to 20.15) and 8.82% (95% CI 5.4 to 14.0), respectively. Univariate analysis of factors associated with DVT showed female sex (P = 0.017), age ≥50 years (P = 0.017), renal replacement therapy (P = 0.005) and femoral venous catheter (P = 0.002) while multivariate analysis showed female sex (P = 0.007; OR = 4.43, 95% CI 1.5 to 13.08), age ≥50 years (P = 0.027; OR = 6.12, 95% CI 1.23 to 30.49), femoral venous catheter (P < 0.001; OR = 11.77, 95% CI 3.11 to 44.53) and the absence of platelet transfusion (P = 0.015; OR = 0.056, 95% CI 0.005 to 0.58). Clinical probability at the first 48 hours but not at days 7, 14 and 28 was strongly correlated with the development of proximal DVT. The duration of mechanical ventilation, the hospital length of stay and the ICU mortality were not affected by the presence of DVT.

Conclusions

Proximal DVT of lower extremities in critically ill medical Thai patients are not uncommon. Thromboprophylaxis study is needed in order to investigate the risk and benefit.