The incidence of deep venous thrombosis in ICU patients.
OBJECTIVE
To determine the incidence, clinical presentation, and risk factors of deep venous thrombosis (DVT) in a high-risk group of ICU patients receiving DVT prophylaxis.


METHODS
A prospective cohort study.


METHODS
Two ICUs of a university-affiliated teaching hospital.


METHODS
Patients admitted to the ICUs within 48 h of hospitalization and who had an ICU stay of > or = 4 days underwent venous duplex scans.


METHODS
None.


RESULTS
One hundred two patients were studied. Ninety-four (92%) patients received DVT prophylaxis. Twelve patients (12%) were documented to have DVT by venous duplex scans. There was proximal clot extension in eight of these patients, four of whom had high-probability ventilation/perfusion scans. Of the 56 patients without signs or symptoms of DVT, only two (3.6%) had abnormal scans. Leg swelling was present in 11 patients, six of whom had DVT (p = 0.004). One of 11 patients with unexplained fever had an abnormal scan. Five of the 26 patients (19%) receiving pneumatic compression developed DVT compared with five of 68 patients (7.4%) receiving subcutaneous heparin (not significant). No specific factor was identified that increased the risk of DVT.


CONCLUSIONS
In this study, the incidence of DVT in a group of high-risk ICU patients receiving DVT prophylaxis was 12%. Since scans in patients without signs or symptoms suggestive of DVT were abnormal in only 3.6% of patients, venous scans should be performed only in patients with features suggestive of DVT or pulmonary embolism.
Marik
P E
PE
Department of Critical Care Medicine, St. Vincent Hospital, Worcester, MA 01604, USA. pmarik@ultranet.com
Andrews
L
L
Maini
B
B
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005676:Gravity Suits; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D006493:Heparin