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Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial

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Abstract

Purpose

We examined the association between surveillance for deep vein thrombosis (DVT) among medical-surgical critically ill patients by twice-weekly ultrasonography and 90-day all-cause mortality.

Methods

This was a pre-planned sub-study of the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (Clinicaltrials.gov: NCT02040103) that compared addition of intermittent pneumatic compression (IPC) to pharmacologic prophylaxis versus pharmacologic prophylaxis alone. The surveillance group included enrolled patients in the trial, while the non-surveillance group included eligible non-enrolled patients. Using logistic regression and Cox proportional hazards models, we examined the association of surveillance with the primary outcome of 90-day mortality. Secondary outcomes were DVT and pulmonary embolism (PE).

Results

The surveillance group consisted of 1682 patients and the non-surveillance group included 383 patients. Using Cox proportional hazards model with bootstrapping, surveillance was associated with a decrease in 90-day mortality (adjusted HR 0.75; 95% CI 0.57, 0.98). Surveillance was associated with earlier diagnosis of DVT [(median 4 days (IQR 2, 10) vs. 20 days (IQR 16, 22)] and PE [median 4 days (IQR 2.5, 5) vs. 7.5 days (IQR 6.1, 28.9)]. There was an increase in diagnosis of DVT (adjusted HR 5.49; 95% CI 2.92, 13.02) with no change in frequency in diagnosis of PE (adjusted HR 0.56; 95% CI 0.19, 1.91).

Conclusions

Twice-weekly surveillance ultrasonography was associated with an increase in DVT detection, reduction in diagnostic testing for non-lower limb DVT and PE, earlier diagnosis of DVT and PE, and lower 90-day mortality.

Trial registration

The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.

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References

  1. Cook DJ, Crowther MA (2010) Thromboprophylaxis in the intensive care unit: focus on medical-surgical patients. Crit Care Med 38:S76–S82

    Article  Google Scholar 

  2. Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH (2001) Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med 161:1268–1279

    Article  CAS  Google Scholar 

  3. Winters B, Custer J, Galvagno SM Jr, Colantuoni E, Kapoor SG, Lee H, Goode V, Robinson K, Nakhasi A, Pronovost P, Newman-Toker D (2012) Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf 21:894–902

    Article  Google Scholar 

  4. Crowther MA, Cook DJ, Griffith LE, Devereaux PJ, Rabbat CC, Clarke FJ, Hoad N, McDonald E, Meade MO, Guyatt GH, Geerts WH, Wells PS (2005) Deep venous thrombosis: clinically silent in the intensive care unit. J Crit Care 20:334–340

    Article  Google Scholar 

  5. Adams RC, Hamrick M, Berenguer C, Senkowski C, Ochsner MG (2008) Four years of an aggressive prophylaxis and screening protocol for venous thromboembolism in a large trauma population. J Trauma 65:300–306

    Article  Google Scholar 

  6. Skrifvars MB, Bailey M, Presneill J, French C, Nichol A, Little L, Duranteau J, Huet O, Haddad S, Arabi Y, McArthur C, Cooper DJ, Bellomo R, Investigators E-T, The ACTG (2017) Venous thromboembolic events in critically ill traumatic brain injury patients. Intensive Care Med 43:419–428

    Article  Google Scholar 

  7. Group PIftCCCT, The A, New Zealand Intensive Care Society Clinical Trials G, Cook D, Meade M, Guyatt G, Walter S, Heels-Ansdell D, Warkentin TE, Zytaruk N, Crowther M, Geerts W, Cooper DJ, Vallance S, Qushmaq I, Rocha M, Berwanger O, Vlahakis NE (2011) Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med 364:1305–1314

    Article  Google Scholar 

  8. De Martino RR, Beck AW, Edwards MS, Corriere MA, Wallaert JB, Stone DH, Cronenwett JL, Goodney PP (2012) Impact of screening versus symptomatic measurement of deep vein thrombosis in a national quality improvement registry. J Vasc Surg 56(1045–1051):e1041

    Google Scholar 

  9. Allen CJ, Murray CR, Meizoso JP, Ginzburg E, Schulman CI, Lineen EB, Namias N, Proctor KG (2016) Surveillance and early management of deep vein thrombosis decreases rate of pulmonary embolism in high-risk trauma patients. J Am Coll Surg 222:65–72

    Article  Google Scholar 

  10. Haut ER, Noll K, Efron DT, Berenholz SM, Haider A, Cornwell EE III, Pronovost PJ (2007) Can increased incidence of deep vein thrombosis (DVT) be used as a marker of quality of care in the absence of standardized screening? The potential effect of surveillance bias on reported DVT rates after trauma. J Trauma 63:1132–1135

    Article  Google Scholar 

  11. Shackford SR, Cipolle MD, Badiee J, Mosby DL, Knudson MM, Lewis PR, McDonald VS, Olson EJ, Thompson KA, Van Gent JM, Zander AL (2016) Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis: a prospective observational study of two centers. J Trauma Acute Care Surg 80:734–739

    Article  Google Scholar 

  12. Samuel S, Patel N, McGuire MF, Salazar M, Nguyen T (2019) Analysis of venous thromboembolism in neurosurgical patients undergoing standard versus routine ultrasonography. J Thromb Thrombolysis 47:209–215

    Article  CAS  Google Scholar 

  13. Malhotra AK, Goldberg SR, McLay L, Martin NR, Wolfe LG, Levy MM, Khiatani V, Borchers TC, Duane TM, Aboutanos MB, Ivatury RR (2014) DVT surveillance program in the ICU: analysis of cost-effectiveness. PLoS ONE 9:e106793

    Article  CAS  Google Scholar 

  14. Dickerson JC, Harriel KL, Dambrino RJ, Taylor LI, Rimes JA, Chapman RW, Desrosiers AS, Tullis JE, Washington CW (2019) Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality. J Neurosurg 1:1–9

    Google Scholar 

  15. Arabi YM, Burns KEA, Al-Hameed F, Alsolamy S, Almaani M, Mandourah Y, Almekhlafi GA, Al Bshabshe A, Alshahrani M, Khalid I, Hawa H, Arshad Z, Lababidi H, Al Aithan A, Jose J, Abdukahil SAI, Afesh LY, Al-Dawood A (2018) Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients: a study protocol and statistical analysis plan. Medicine 97:e12258

    Article  Google Scholar 

  16. Arabi Y, Al-Hameed F, Burns KEA, Mehta S, Alsolamy S, Almaani M, Mandourah Y, Almekhlafi GA, Al Bshabshe A, Finfer S, Alshahrani M, Khalid I, Mehta Y, Gaur A, Hawa H, Buscher H, Arshad Z, Lababidi H, Al Aithan A, Jose J, Abdukahil SAI, Afesh LY, Dbsawy M, Al-Dawood A, Group Pt (2018) Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial. Trials 19:182

    Article  CAS  Google Scholar 

  17. Arabi YM, Alsolamy S, Al-Dawood A, Al-Omari A, Al-Hameed F, Burns KE, Almaani M, Lababidi H, Al Bshabshe A, Mehta S, Al-Aithan AM, Mandourah Y, Mekhlafi G, Finfer S, Abdukahil SA, Afesh LY, Dbsawy M, Sadat M (2016) Thromboprophylaxis using combined intermittent pneumatic compression and pharmacologic prophylaxis versus pharmacologic prophylaxis alone in critically ill patients: study protocol for a randomized controlled trial. Trials 17:390

    Article  CAS  Google Scholar 

  18. Arabi YM, Al-Hameed F, Burns KEA, Mehta S, Alsolamy SJ, Alshahrani MS, Mandourah Y, Almekhlafi GA, Almaani M, Al Bshabshe A, Finfer S, Arshad Z, Khalid I, Mehta Y, Gaur A, Hawa H, Buscher H, Lababidi H, Al Aithan A, Abdukahil SAI, Jose J, Afesh LY, Al-Dawood A (2019) Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Engl J Med 380(14):1305–1315

    Article  Google Scholar 

  19. Lensing AW, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, Wouter Ten Cate J, Huisman MV, Buller HR (1989) Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 320:342–345

    Article  CAS  Google Scholar 

  20. Mattos MA, Londrey GL, Leutz DW, Hodgson KJ, Ramsey DE, Barkmeier LD, Stauffer ES, Spadone DP, Sumner DS (1992) Color-flow duplex scanning for the surveillance and diagnosis of acute deep venous thrombosis. J Vasc Surg 15:366–375

    Article  CAS  Google Scholar 

  21. Monreal M, Montserrat E, Salvador R, Bechini J, Donoso L, MaCallejas J, Foz M (1989) Real-time ultrasound for diagnosis of symptomatic venous thrombosis and for screening of patients at risk: correlation with ascending conventional venography. Angiology 40:527–533

    Article  CAS  Google Scholar 

  22. Kearon C, Ginsberg JS, Hirsh J (1998) The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med 129:1044–1049

    Article  CAS  Google Scholar 

  23. Cook D, McMullin J, Hodder R, Heule M, Pinilla J, Dodek P, Stewart T, Canadian ICUDG (2001) Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey. Crit Care (Lond, Engl) 5:336–342

    Article  CAS  Google Scholar 

  24. Cook D, Meade M, Guyatt G, Griffith L, Granton J, Geerts W, Crowther M (2004) Clinically important deep vein thrombosis in the intensive care unit: a survey of intensivists. Crit Care 8:R145–R152

    Article  Google Scholar 

  25. Harris LM, Curl GR, Booth FV, Hassett JM Jr, Leney G, Ricotta JJ (1997) Screening for asymptomatic deep vein thrombosis in surgical intensive care patients. J Vasc Surg 26:764–769

    Article  CAS  Google Scholar 

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Funding

The PREVENT trial was funded by King Abdulaziz City for Science and Technology (Grant AT 34-65) and King Abdullah International Medical Research Center (Grant RC12/045/R), both in Riyadh, Saudi Arabia. The funding agencies had no role in study design or conduct, data collection, statistical analysis, or writing of the manuscript.

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Correspondence to Yaseen M. Arabi.

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Arabi, Y.M., Burns, K.E.A., Alsolamy, S.J. et al. Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial. Intensive Care Med 46, 737–746 (2020). https://doi.org/10.1007/s00134-019-05899-1

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