[D-dimer screening in surgical long-term intensive care patients].
BACKGROUND
Clinically unrecognized thrombosis with the danger of a pulmonary embolism represents an underestimated problem in surgical ICU patients. In patients undergoing total hip replacement for instance, over 30% develop a clinically inapparent form of thrombosis, despite initial thrombosis prophylaxis. We tried to recognize clinically inapparent thrombosis in long-term intensive care patients using D-dimer screening and ultrasound imaging.


METHODS
All surgical long-term ICU patients received intravenous heparin 5-10 IU/kg body weight and a D-dimer was assay was carried out every 2 days. If the D-dimer level surpassed 2 mg/l, ultrasound imaging of the veins in the legs, pelvis, arms and neck was performed.


RESULTS
Included in the study were 50 patients and D-dimer levels above 2 mg/l were detected in 38%. A thrombosis was proven in 63% of the patients with D-dimer values above 2 mg/l and 50% of the thrombosis were detected in the arm and neck veins very often associated with intravenous catheters.


CONCLUSIONS
Routine D-dimer screening and specific use of ultrasound imaging appears to be a valuable method to verify clinically inapparent thromboses in surgical ICU patients.
Hilbert
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P
Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, BG Kliniken Bergmannstrost, Halle. Peter.Hilbert@bergmannstrost.com
Zur Nieden
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Stuttmann
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D019644:Arthroplasty, Replacement, Hip; D015415:Biomarkers; D003422:Critical Care; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control*; D018570:Risk Assessment; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control*; D014463:Ultrasonography
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D006493:Heparin