Pulmonary Vascular Disease |

Venous Thromboembolism in the Medical Intensive Care Unit. Is Wells Score Predictive? FREE TO VIEW

Trupti Vakde*, MD; Ajit Lale, MD; Misbahuddin Khaja, MD; Gilda Diaz-Fuentes, MD; Sindhaghatta Venkatram, MD
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Bronx Lebanon Hospital Center, New York, NY

Chest. 2012;142(4_MeetingAbstracts):856A. doi:10.1378/chest.1388407
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PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Prevalence of venous thromboembolism (VTE) in medical intensive care units (MICU) is estimated to be between 1.9- 33 percent. Specific risk factors for thrombosis in the ICU include mechanical ventilation, immobility, and the use of femoral venous catheters, sedatives, and paralytic drugs. Both DVT and PE are difficult to diagnose because of the poor sensitivity and specificity of clinical symptoms and signs. The utility of clinical decision making algorithms like Wells score in MICU patients remains unknown. The goal of the study was to evaluate the utility of Wells score in patients who developed VTE during MICU stay.

METHODS: Retrospectively review of all patients admitted to MICU between January 2009 and December 2010. Denovo VTE was defined as those VTEs occurring after three days of MICU admission for a non-VTE diagnosis. All patients with imaging studies for VTE after three days of MICU admission were included in the study. Primary outcome was the correlation of Wells score in diagnosis of VTE. In addition, APACHE IV score, mortality rates, MICU length of stay (LOS), cardiac troponin levels, A-a gradient, Pro-BNP, platelet count and albumin levels between the two groups were compared.

RESULTS: Of the 4628 admissions in the study period, 162 (3.5%) patients underwent imaging for presumptive VTE. Twenty-four of the 162 (14.8%) patients had VTE. All patients received DVT prophylaxis. There was no difference in age, gender, APACHE score, requirement for mechanical ventilation for the groups. Wells score in patients with VTE was 2.8±1.9 versus 2.5±1.7; p=0.43(95%CI-0.45 to 1.05). There was no difference between MICULOS, A-a gradient, BNP, platelet count and albumin levels. Patients with VTE had a higher troponins (0.659±1.9 versus 0.125±0.3;P=0.002) and higher mortality 58% versus 26% P=0.003.

CONCLUSIONS: Wells score was not predictive for denovo VTE in a MICU. Patients with VTE had higher troponin levels and increased mortality when compared to patients without VTE.

CLINICAL IMPLICATIONS: Wells score is not reliable for clinical decision making in MICU patients suspected of VTE. Incorporation of troponin levels with scoring systems may be helpful in predicting denovo VTE. DVT prophylaxis does not prevent VTE in all the patients.

DISCLOSURE: The following authors have nothing to disclose: Trupti Vakde, Ajit Lale, Misbahuddin Khaja, Gilda Diaz-Fuentes, Sindhaghatta Venkatram

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Bronx Lebanon Hospital Center, New York, NY




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