PURPOSE: Prevention of deep vein thrombosis (DVT) is one of the most important patient safety healthcare challenges today. Malignancy and admission to the intensive care unit (ICU) are both independent risk factors for the development of DVT. However, many cancer patients are thrombocytopenic and do not receive prophylaxis under the assumption that low platelets are protective against thrombus formation. Our 53-bed oncologic ICU provides a unique venue in which to study the incidence of DVT in critically ill cancer patients with varying degrees of thrombocytopenia.
METHODS: A retrospective analysis was conducted on patients who were > 18 years old with underlying malignancy and were admitted to our ICU over 12 consecutive months. Data included nadir platelet counts at ICU admission and within 24 hours of a DVT event, as well as incidence of DVT during the ICU stay.
RESULTS: We reviewed the ICU records of 2240 patients. We observed 46 DVTs; 57% (n=1,527) had an ICU admission nadir platelet count > 150,000/microliter. The nadir platelet count had no significant effect on the incidence of DVT (p=0.83). Nadir platelet counts were subcategorized: 1) <20,000; 2) 20,000-50,000; 3) 50,000-100,000; 4) 100,000-150,000; and 5) >150,000/microliter. DVT rates for these groups were not significantly different (0.014, 0.004, 0.028, 0.021, and 0.017, respectively; p=0.08). Among DVT patients, there was also no significant difference between admission nadir platelet count and nadir platelet count within 24 hours prior to the event (p=0.41).
CONCLUSIONS: Thrombocytopenia did not “protect” patients against DVT. DVT incidence in thrombocytopenic critically ill cancer patients was similar to the incidence in critically ill cancer patients with normal platelet counts.
CLINICAL IMPLICATIONS: These results suggest that a low platelet count is not protective against the development of DVT in this population, and that there is a need to investigate and implement adequate prophylactic measures in thrombocytopenia to minimize this potentially devastating complication.
DISCLOSURE: The following authors have nothing to disclose: Sajid Haque, Andrew Dinh, Nisha Rathi, Lei Feng, Mick Owen, Georgia Lange, Kristen Price, Joseph Nates
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