SESSION TITLE: Evaluation and Management of Venous Thromboembolism
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 04:30 PM - 05:30 PM
PURPOSE: Deep venous thrombosis (DVT) is common in critically ill mechanically ventilated patents, and may be complicated by pulmonary embolism and death in such patients. Thromboprophylaxis with heparin is not always effective in preventing DVT and PE in such patients. Recent trials have shown that aspirin may prevent recurrent venous thromboembolism in treated patients. However, it is unknown if aspirin may prevent DVT in critically ill mechanically ventilated patients most of whom receive thromboprophylaxis.
METHODS: We performed a retrospective chart review of critically ill patients who received mechanical ventilation for > 72 hours and underwent venous ultrasonography for suspected DVT between Jan 2012 and Dec 2013. We excluded patients who were on therapeutic doses of anticoagulation or had coagulopathy. Multivariable logistic regression was used to evaluate association between aspirin use and development of DVT during hospitalization.
RESULTS: There was a total of 193 patients after exclusions. The mean (± SD) age was 58 (±15.7) years and 50% were males. Deep venous thrombosis was found in 49 (25.4%) patients and involved the upper extremity in 28 (57%) of them. DVT was catheter related in 17 (34.6%) patients. DVT was found in the first 15 days of hospitalization in 67.3% of the patients. The majority (n = 159, 82.8%) of patients received chemical thromboprophylaxis. Fifty three (26.7%) patients were on aspirin. On multivariable regression analysis, use of aspirin was associated with a 60% reduction in the odds of finding DVT (OR 0.39, 95% CI 0.16 to 0.94; p = 0.036). Table 3: MULTIVARIATE ADJUSTED REGRESSION ANALYSIS VARIABLE ODDS RATIO (95% CI) P ValueAspirin 0.39 (0.16-0.94) 0.03 Age 1.00 (0.98-1.02) 0.64 Gender 1.46 (0.74-2.90) 0.28 Days since Hospitalization 0.93 (0.83- 1.05) 0.27 DVT prophylaxis (chemical) 0.71 (0.30-1.69) 0.56 IV Catheter Central Venous Catheters 2.90 (0.78-10.74) 0.11 PICC 1.52 (0.29-8.02) 0.62
CONCLUSIONS: In this cohort of mechanically ventilated patients, we found upper extremity DVTs to be more common than lower extremity DVT. We found use of aspirin, in addition to the use of standard chemical or mechanical prophylaxis, was associated with lower incidence of DVT in critically ill mechanically ventilated patients.
CLINICAL IMPLICATIONS: Deep venous thrombosis is common in critically ill mechanically ventilated patients despite the use of prophylaxis. Aspirin may prevent DVT in such patients.
DISCLOSURE: The following authors have nothing to disclose: Ena Gupta, Furqan Siddiqi, Ryan Kunjal, Muhammad Faisal, Farah Al-Saffar, Lisa Jones, Vandana Seeram, James Cury, Abubakr Bajwa, Adil Shujaat
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