University Health System, San Antonio, TX, USA.
College of Pharmacy, Pharmacotherapy Division, The University of Texas at Austin, Austin, TX, USA.
Neurocrit Care. 2019 Jun;30(3):645-651. doi: 10.1007/s12028-018-0652-3.
BACKGROUND/OBJECTIVES: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are complications of hospitalization leading to increased morbidity and mortality. Routine surveillance ultrasound has become common practice in some intensive care units (ICU) to detect DVT early and initiate anticoagulation, preventing complications. However, initiating anticoagulants for asymptomatic DVT treatment may increase risk of hemorrhage. The objective of this study was to investigate the value of routine surveillance ultrasound in early DVT diagnosis in Neuro ICU patients.
This is a retrospective review of patients diagnosed with DVT during admission to the Neuro ICU at University Hospital from January 1, 2012, through December 31, 2017. Patients were identified through International Classification of Diseases 9th and 10th Revision codes for DVT and PE, screened for inclusion criteria, and then classified as surveillance group or symptom-driven group based on intervention received. Primary outcome was time to DVT diagnosis. Secondary outcome included clinically significant hemorrhage identified by anticoagulation treatment discontinuation for suspected hemorrhage or new or expanding hemorrhage on head computerized tomography (CT).
A total of 116 patients were identified, with 50 included: 27 were classified as surveillance and 23 as symptom-driven. Seven patients (surveillance = 3 and symptom-driven = 4) were diagnosed with only PE and were excluded from primary outcome. Median time to DVT diagnosis was similar at 148 h for surveillance versus 172 h for symptom driven (p = 0.2). There was no difference in treatment discontinuation rates (surveillance 21% vs symptom 31%; p = 0.4). Of the 27 patients with follow-up head CT, two in the surveillance group and two in the symptom-driven group showed a new or expanding hemorrhage.
Routine surveillance ultrasound did not lead to significantly earlier DVT diagnosis. Hemorrhagic events were not different between groups. Utility of surveillance ultrasound in this population should be evaluated in large, prospective trials before routine use can be recommended.
背景/目的：深静脉血栓形成（DVT）和肺栓塞（PE）是住院的并发症，导致发病率和死亡率增加。常规监测超声已成为一些重症监护病房（ICU）的常见做法，以早期发现 DVT 并启动抗凝治疗，预防并发症。然而，为无症状 DVT 治疗启动抗凝剂可能会增加出血风险。本研究的目的是探讨常规监测超声在神经 ICU 患者早期 DVT 诊断中的价值。
这是一项对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间入住大学医院神经 ICU 的患者进行的回顾性研究。通过国际疾病分类第 9 版和第 10 版的 DVT 和 PE 代码对患者进行诊断，筛选出符合纳入标准的患者，然后根据接受的干预措施分为监测组或症状驱动组。主要结局为 DVT 诊断时间。次要结局包括因疑似出血或头部计算机断层扫描（CT）显示新的或扩大的出血而停止抗凝治疗而识别出的临床显著出血。
共确定了 116 名患者，其中 50 名患者被纳入：27 名被分类为监测组，23 名被分类为症状驱动组。7 名患者（监测组 3 名，症状驱动组 4 名）仅诊断为 PE，因此被排除在主要结局之外。监测组的 DVT 诊断中位时间为 148 小时，症状驱动组为 172 小时，两组间无差异（p=0.2）。两组停药率无差异（监测组 21% vs 症状组 31%；p=0.4）。在接受随访头部 CT 的 27 名患者中，监测组有 2 名和症状驱动组有 2 名患者出现新的或扩大的出血。
常规监测超声并未导致 DVT 诊断显著提前。两组间出血事件无差异。在推荐常规使用之前，应在大型前瞻性试验中评估该人群中监测超声的效用。
