Permpikul Chairat, Chaiyasoot Walailak, Panitchote Anupol
Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thromb J. 2022 Feb 5;20(1):5. doi: 10.1186/s12959-022-00363-5.
Approximately 13-31% of medical critical care patients develop deep vein thrombosis (DVT). However, there are very few reports regarding the incidence of DVT among Asian patients without routine prophylaxis. The objectives of this study were to assess the prevalence and incidence proportion of proximal DVT in Thai medical critical care patients not receiving thrombosis prophylaxis.
We conducted a prospective cohort study in medical critical care patients admitted to Siriraj Hospital, Thailand between November 2008 and November 2009. Patients were screened for proximal DVT by duplex ultrasonography performed 48 h, 7, 14 and 28 days after admission. Primary outcomes were prevalence and incidence proportion of DVT. Factors associated with the development of proximal DVT were evaluated by multivariate analysis.
Of the 158 patients enrolled in the study, 25 had proximal DVT (15.8%). Nine patients (5.7%) had DVT on the first test at 48 h, while 10 (6.3%), 2 (1.3%) and 4 (2.5%) patients had developed DVT on days 7, 14, and 28, respectively. Thus, the prevalence at the beginning of the study was 5.7% (95%CI 2.6-10.5) and the incidence proportion was 10.1% (95%CI 5.9-15.9). The multivariate analysis showed that age (odds ratio [OR] per 1-year increase was 1.04, 95% confidence interval [CI] 1.01-1.07), female gender (OR 4.05, 95%CI 1.51-12.03), femoral venous catheter (OR 11.18, 95%CI 3.19-44.83), and the absence of platelet transfusion (OR 0.07, 95%CI 0.003-0.43) were associated with the development of proximal DVT. Patients with proximal DVT had a longer hospital length of stay (22 days [IQR 11-60] vs. 14 days [7-23], p = 0.03) and spent more time on mechanical ventilation (10 days (3.3-57) vs. 6 days (3-12), p = 0.053) than patients without DVT. Patient mortality was not affected by the presence of DVT (52% vs. 38.3%, p = 0.29).
Routine thromboprophylaxis is not used in our institution and the prevalence and incidence proportion of proximal DVT in Asian medical critical care patients were both substantial. Patients with older age, female gender, an intravenous femoral catheter, and the absence of platelet transfusion all had a higher chance of developing proximal DVT.
约13%-31%的医学重症监护患者会发生深静脉血栓形成（DVT）。然而，关于未进行常规预防的亚洲患者中DVT发病率的报道非常少。本研究的目的是评估未接受血栓预防的泰国医学重症监护患者近端DVT的患病率和发病率。
我们对2008年11月至2009年11月期间入住泰国诗里拉吉医院的医学重症监护患者进行了一项前瞻性队列研究。患者在入院后48小时、7天、14天和28天接受双功超声检查以筛查近端DVT。主要结局是DVT的患病率和发病率。通过多变量分析评估与近端DVT发生相关的因素。
在纳入研究的158例患者中，25例发生近端DVT（15.8%）。9例患者（5.7%）在48小时首次检查时发生DVT，而分别有10例（6.3%）、2例（1.3%）和4例（2.5%）患者在第7天、14天和28天发生DVT。因此，研究开始时的患病率为5.7%（95%CI 2.6-10.5），发病率为10.1%（95%CI 5.9-15.9）。多变量分析显示，年龄（每增加1岁的优势比[OR]为1.04，95%置信区间[CI] 1.01-1.07）、女性（OR 4.05，95%CI 1.51-12.03）、股静脉导管（OR 11.18，95%CI 3.19-44.83）以及未进行血小板输注（OR 0.07，95%CI 0.003-0.43）与近端DVT的发生相关。发生近端DVT的患者住院时间更长（22天[IQR 11-60] vs. 14天[7-23]，p = 0.03），机械通气时间更长（10天（3.3-57）vs. 6天（3-12），p = 0.053）。DVT的存在不影响患者死亡率（52% vs. 38.3%，p = 0.29）。
我们机构未使用常规血栓预防措施，亚洲医学重症监护患者近端DVT的患病率和发病率都很高。年龄较大、女性、有股静脉导管以及未进行血小板输注的患者发生近端DVT的几率更高。
