The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study

Ting-Lung Lin; Wen-Hao Liu; Wei-Hung Lai; Ying-Ju Chen; Po-Hsun Chang; I-Ling Chen; Wei-Feng Li; Yueh-Wei Liu; Eric J Ley; Chih-Chi Wang

doi:10.1177/17511437231214906

The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study

J Intensive Care Soc. 2023 Dec 28;25(2):140-146. doi: 10.1177/17511437231214906. eCollection 2024 May.

Authors

Ting-Lung Lin^{1

2}, Wen-Hao Liu^{2

3}, Wei-Hung Lai^{1

2}, Ying-Ju Chen^{1

2}, Po-Hsun Chang^{2

4}, I-Ling Chen^{2

4

5}, Wei-Feng Li^{1

2}, Yueh-Wei Liu^{1

2}, Eric J Ley⁶, Chih-Chi Wang^{1

2}

Affiliations

¹ Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
² Chang Gung University College of Medicine, Kaohsiung, Taiwan.
³ Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁴ Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁵ School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Background: Venous thromboembolism (VTE) in critically ill patients has been well-studied in Western countries. Many studies have developed risk assessments and established pharmacological protocols to prevent deep venous thrombosis (DVT). However, the DVT rate and need for pharmacologic VTE prophylaxis in critically ill Taiwanese patients are limited. This study aimed to prospectively determine the DVT incidence, risk factors, and outcomes in critically ill Taiwanese patients who do not receive pharmacologic VTE prophylaxis.

Methods: We conducted a prospective study in a surgical intensive care unit (SICU) of a tertiary academic medical center in Taiwan. Adult patients admitted to SICU from March 2021 to June 2022 received proximal lower extremities DVT surveillance with venous duplex ultrasound. No patient received pharmacologic VTE prophylaxis. The outcomes were the incidence and risk factors of DVT.

Results: Among 501 enrolled SICU patients, 21 patients (4.2%) were diagnosed with proximal lower extremities DVT. In a multivariate regression analysis, hypoalbuminemia (odd ratio (OR) = 6.061, 95% confidence interval (CI): 1.067-34.421), femoral central venous catheter (OR = 4.515, 95% CI: 1.547-13.174), ICU stays more than 10 days (OR = 4.017, 95% CI: 1.270-12.707), and swollen leg (OR = 3.427, 95% CI: 1.075-10.930) were independent risk factors for DVT. In addition, patients with proximal lower extremities DVT have more extended ventilator days (p = 0.045) and ICU stays (p = 0.044).

Conclusion: Our findings indicate critically ill Taiwanese patients have a higher incidence of DVT than results from prior retrospective studies in the Asian population. Physicians who care for this population should consider the specific risk factors for DVT and prescribe pharmacologic prophylaxis in high-risk groups.

Keywords: Venous thromboembolism; deep vein thrombosis; lower extremities; surgical critically ill; surgical intensive care unit.