Prophylaxis and incidence of symptomatic deep vein thrombosis in indian patients with sepsis: DETECT-deep vein thrombosis registry
Doppler ultrasonography, heparin (low molecular weight), Indian study (prospective), sepsis, venous thrombosis
Citation Information :
Investigators D. Prophylaxis and incidence of symptomatic deep vein thrombosis in indian patients with sepsis: DETECT-deep vein thrombosis registry. Indian J Crit Care Med 2017; 21 (11):765-771.
Purpose: To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis.
Materials and Methods: Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 ± 7 days (if discharged before 30 days).
Results: The study included 278 patients (men: 69.4%; mean age: 56.3 ± 17.99 years). Out of 275 patients (data missing for 3 patients), 188 (68.4%; 95% confidence interval: 62.5–73.8) received DVT prophylaxis (185 at admission and 3 at discharge; pharmacological prophylaxis: n = 88, mechanical prophylaxis: n = 65, pharmacological + mechanical prophylaxis: n = 35) and 87 received no prophylaxis. In line with American College of Chest Physicians 2008 recommendations, among patients who received pharmacological prophylaxis (n = 123), low-molecular-weight heparin was given to 85.4% (n = 105) patients (duration: 9.1 ± 6.36 days), unfractionated heparin to 12.2% (n = 15) patients (duration: 9.2 ± 9.18 days), and fondaparinux to 5.7% (n = 7) patients (duration: 6.8 ± 3.30 days); 27/63 patients at high-risk of bleeding received mechanical prophylaxis; no patient received aspirin. Of 9 patients who developed DVT, 7 received no thromboprophylaxis (data missing for 2 patients). In total, 186/274 (67.9%) patients recovered from sepsis.
Conclusions: Two-third patients received thromboprophylaxis. The substantial role of thromboprophylaxis in DVT prevention mandates monitoring and control of thromboprophylaxis through internal audits in hospitals.
Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840-51.
Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014;5:4-11.
Todi S, Chatterjee S, Bhattacharyya M. Epidemiology of severe sepsis in India. Crit Care 2007;11 Suppl 2:P65.
Saracco P, Vitale P, Scolfaro C, Pollio B, Pagliarino M, Timeus F, et al. The coagulopathy in sepsis: Significance and implications for treatment. Pediatr Rep 2011;3:e30.
Dellinger RP. Inflammation and coagulation: Implications for the septic patient. Clin Infect Dis 2003;36:1259-65.
Levi M, Levy M, Williams MD, Douglas I, Artigas A, Antonelli M, et al. Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated). Am J Respir Crit Care Med 2007;176:483-90.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.
Cade JF. High risk of the critically ill for venous thromboembolism. Crit Care Med 1982;10:448-50.
Halkin H, Goldberg J, Modan M, Modan B. Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis. Ann Intern Med 1982;96:561-5.
Liew NC, Chang YH, Choi G, Chu PH, Gao X, Gibbs H, et al. Asian venous thromboembolism guidelines: Prevention of venous thromboembolism. Int Angiol 2012;31:501-16.
Cheng G, Chan C, Liu YT, Choy YF, Wong MM, Yeung PK, et al. Incidence of deep vein thrombosis in hospitalized Chinese medical patients and the impact of DVT prophylaxis. Thrombosis 2011;2011:629383.
Gandharba Ray MB. Venous thromboembolism- Indian perspective. Med Update 2010;20:329-34.
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock; 2012. Available from: http://www.guideline.gov/content.aspx?id=43904. [Last accessed on 2017 Feb 10].
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31:1250-6.
Pandey A, Patni N, Singh M, Guleria R. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country. Vasc Health Risk Manag 2009;5:643-8.
Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 2007;119:145-55.
Robertson MS, Nichol AD, Higgins AM, Bailey MJ, Presneill JJ, Cooper DJ, et al. Venous thromboembolism prophylaxis in the critically ill: A point prevalence survey of current practice in Australian and New Zealand Intensive Care Units. Crit Care Resusc 2010;12:9-15.
Lentine KL, Flavin KE, Gould MK. Variability in the use of thromboprophylaxis and outcomes in critically ill medical patients. Am J Med 2005;118:1373-80.
Mahan CE, Spyropoulos AC. ASHP therapeutic position statement on the role of pharmacotherapy in preventing venous thromboembolism in hospitalized patients. Am J Health Syst Pharm 2012;69:2174-90.
Arnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of venous thromboembolism: An evaluation of the use of thromboprophylaxis guidelines. Chest 2001;120:1964-71.
Ho KM, Chavan S, Pilcher D. Omission of early thromboprophylaxis and mortality in critically ill patients: A multicenter registry study. Chest 2011;140:1436-46.
Lauzier F, Muscedere J, Deland E, Kutsogiannis DJ, Jacka M, Heels-Ansdell D, et al. Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit. Crit Care 2014;18:R82.
Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in nonsurgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e195S-226S.
Robinson S, Toft P. Thromboprophylaxis for intensive care patients. Br J Med Med Res 2014;4:46.
Rothberg MB, Pekow PS, Lahti M, Lindenauer PK. Comparative effectiveness of low-molecular-weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients. J Hosp Med 2012;7:457-63.
Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: Systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess 2005;9:iii-iv, ix-x, 1-78.