We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial.
- Authors
Arabi, Yaseen M.; Burns, Karen E. A.; Alsolamy, Sami J.; Alshahrani, Mohammed S.; Al-Hameed, Fahad M.; Arshad, Zia; Almaani, Mohammed; Hawa, Hassan; Mandourah, Yasser; Almekhlafi, Ghaleb A.; Al Aithan, Abdulsalam; Khalid, Imran; Rifai, Jalal; Rasool, Gulam; Abdukahil, Sheryl Ann I.; Jose, Jesna; Afesh, Lara Y.; Al-Dawood, Abdulaziz; Saudi Critical Care Trials Group
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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).<bold>Results: </bold>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).<bold>Conclusions: </bold>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.<bold>Trial Registration: </bold>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.
- Subjects
VENOUS thrombosis; CRITICALLY ill; PROPORTIONAL hazards models; ULTRASONIC imaging; PULMONARY embolism
- Publication
Intensive Care Medicine, 2020, Vol 46, Issue 4, p737
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-019-05899-1