J Korean Acad Nurs.  2012 Jun;42(3):396-404. 10.4040/jkan.2012.42.3.396.

Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities

• Kim H
• Cho OM
• Cho HI
• Kim JY

• KMID: 1785224
• DOI: http://doi.org/10.4040/jkan.2012.42.3.396

Abstract

PURPOSE
The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities.
METHODS
The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit.
RESULTS
The mean age was 62.24 (+/-17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(+/-2.94) and they had on average 4.01(+/-1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis.
CONCLUSION
Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

Keyword

Critical illness; Venous thrombosis; Risk factors

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Body Mass Index
*Critical Illness
Female
Humans
Leg/*blood supply
Logistic Models
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Prospective Studies
Risk Factors
Venous Thrombosis/diagnosis/*etiology
Young Adult

Reference

References

Bang S. M.., Jang M. J.., Oh D.., Kim Y. K.., Kim I. H.., Yoon S. S., et al2010. Korean guidelines for the prevention of venous thromboembolism. Journal of Korean Medical Science. 25:1553–1559. http://dx.doi.org/10.3346/jkms.2010.25.11.1553.

Beck D.M. 2006. Venous thromboembolism(VTE) prophylaxis: Implications for medical-surgical nurses. MEDSURG Nursing. 15(5):282–287.

Caprini J.A. 2005. Thrombosis risk assessment as a guide to quality patients care. Disease-a-Month. 51:70–78. http://dx.doi.org/10.1016/j.disamonth.2005.02.003.

Choi D.., Min H.S. 2011. Nurse's knowledge and compliance on deep vein thrombosis. Journal of Korean Critical Care Nursing. 4:75–87.

Choo S. K.., Lee C. S.., Seo J. G.., Kim Y.C. 2006. Color doppler sonography surveillance for deep vein thrombosis after hip surgery. The Journal of the Korean Hip Society. 18:61–66.

Cook D.., Crowther M.., Meade M.., Rabbat C.., Griffith L.., Schiff D., et al2005. Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors. Critical Care Medicine. 33(7):1565–1571. http://dx.doi.org/10.1097/01.CCM.0000171207.95319.B2.

Cook D. J.., Crowther M.A. 2010. Thromboprophylaxis in the intensive care unit: Focus on medical-surgical patients. Critical Care Medicine. 38(2 Suppl):S76–S82. http://dx.doi.org/10.1097/CCM.0b013e3181c9e344.

Crowther M. A.., Cook D. J.., Griffith L. E.., Devereaux P. J.., Rabbat C. C.., Clarke F. J., et al2005. Deep venous thrombosis: Clinically silent in the intensive care unit. Journal of Critical Care. 20:334–340. http://dx.doi.org/10.1016/j.jcrc.2005.09.011.

Geerts W.., Cook D.., Selby R.., Etchells, E. 2002. Venous thromboembolism and its prevention in critical care. Journal of Critical Care. 17(2):95–104.

Geerts W.., Selby, R. 2003. Prevention of venous thromboembolism in the ICU. Chest. 124(6, Suppl):357S–363S. http://dx.doi.org/10.1378/chest.124.6_suppl.357S.

Goldhaber S. Z.., Grodstein F.., Stampfer M. J.., Manson J. E.., Colditz G. A.., Speizer F. E., et al1997. A prospective study of risk factors for pulmonary embolism in women. The Journal of the American Medical Association. 277:642–645. http://dx.doi.org/10.1001/jama.1997.03540320044033.

John A.., Heit, M. 2003. Risk factor for venous thromboembolism. Clinics in Chest Medicine. 24:1–12. http://dx.doi.org/10.1016/S0272-5231(02)00077-1.

Keenan C. R.., White R.H. 2007. The effects of race/ethnicity and sex on the risk of venous thromboembolism. Current Opinion in Pulmonary Medicine. 13:377–383.

Kim K. S.., Brophy G.M. 2009. Symptomatic venous thromboembolism: Incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage. Neurocritical Care. 11:28–33. http://dx.doi.org/10.1007/s12028-009-9201-4.

Kim K. I.., Cho K. Y.., Jin W.., Khurana S. S.., Bae D.K. 2011. Recent Korean perspective of deep vein thrombosis after total knee arthroplasty. The Journal of Arthroplasty. 26(7):1112–1116.

Kim I. G.., Kim K. H.., Seo H. J.., Kim J. I.., Ahn C. H.., Kim J. S., et al2004. Deep vein thrombosis after surgery for gastrointestinal cancer, incidence and correlation with risk factors. The Journal of the Korean Vascular Surgery Society. 20:237–241.

Kim J. S.., Kim H. J.., Woo Y. H.., Lym J. Y.., Lee C.H. 2009. Effects on changes in femoral vein blood flow velocity with the use of lower extremity compression for critical patients with brain injury. Journal of Korean Academy of Nursing. 39:288–297. http://dx.doi.org/10.4040/jkan.2009.39.2.288.

Korean Society on Thrombosis and Hemostasis. 2009. Japanese guideline for prevention of venous thromboembolism: Partial revision based on domestic situation. Seoul: Author.

Muscedere J. G.., Heyland D. K.., Cook, D. 2007. Venous thromboembolism in critical illness in a community intensive care unit. Journal of Critical Care. 22:285–289. http://dx.doi.org/10.1016/j.jcrc.2007.02.003.

Park H. S.., Park C. Y.., Oh S. W.., Yoo H.J. 2008. Prevalence of obesity and metabolic syndrome in Korean adult. Obesity Reviews. 9:104–107. http://dx.doi.org/10.1111/j.1467-789X.2007.00421.x.

Phillips L.., Macmillan A.., Tweed, C. 2004. Review of intermittent pneumatic compression: An evidence-based therapeutic modality for the prevention of avoidable deep vein thrombosis. Journal of Integrated Care Pathways. 8:55–58.

Schuerer D.., Whinney R.., Freeman B.., Nash J.., Prasad S.., Krem M., et al2005. Evaluation of the applicability, efficacy, and safety of a thromboembolic event prophylaxis guideline designed for quality improvement of the traumatically injured patient. The Journal of TRAUMA: Injury, Infection, and Critical Care. 58:731–739. http://dx.doi.org/10.1097/01.TA.0000158247.77198.AD.

Taniguchi S.., Fukuda I.., Daitoku K.., Minakawa M.., Odagiri S.., Suzuki Y., et al2009. Prevalence of venous thromboembolism in neurosurgical patients. Heart Vessels. 24:425–428. http://dx.doi.org/10.1007/s00380-008-1135-9.

Wilasrusmee C.., Kiranantawat K.., Horsirimanont S.., Lertsithichai P.., Reo-decha P.., Soonthonkit Y., et al2009. Deep venous thrombosis in surgical intensive care unit: Prevalence and risk factors. Asian Journal of Surgery. 32:85–88. http://dx.doi.org/10.1016/S1015-9584(09)60016-6.

Xu X. F.., Yang Y. H.., Zhai Z. G.., Liu S.., Zhu G. F.., Li C. S., et al2008. Prevalence and incidence of deep venous thrombosis among patients in medical intensive care unit. Zhonghua Liu Xing Bing Xue Za Zhi. 29:1034–1037.

Yablon S. A.., Rock W. A. Jr.., Nick T. G.., Sherer M.., McGrath C. M.., Good-son K.H. 2004. Deep vein thrombosis: Prevalence and risk factors in rehabilitation admissions with brain injury. Neurology. 63:485–491. http://dx.doi.org/10.1212/01.WNL.0000133009.24727.9F.

Yim S. J.., Woo S. H.., Byun I.W. 2007. The effects of foot pump on prevention of deep vein thrombosis following total knee arthroplasty. Journal of Korean Knee Society. 19:135–141.