Rate of Lower Extremity Deep Vein Thrombosis Higher in Critical Trauma Patients

New duplex ultrasound screening study includes detection of calf vein deep vein thrombosis

Newswise — CHICAGO - A study published in the September 2011 issue of the Journal of Vascular Surgery®, the official publication of the Society for Vascular Surgery®, reports that a high rate of lower deep vein thromboses (LDVT’s) in critically ill trauma cases can be detected through duplex ultrasound screening (DUS).

“Lower extremity deep vein thrombosis (LEDVT) is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, deep vein thrombosis (DVT) risk factors or pharmacologic prophylaxis,” said Amir Azarbal, MD of the department of surgery at Oregon Health and Sciences University (OHSU) in Portland, Oregon. “However, previous studies have underestimated DVT rates by not including calf vein thromboses (CVDTs) and not exclusively targeting critically ill patients.”

The current study retrospectively reviewed the medical records of 264 intensive care unit trauma patients received DUS for LEDVT between January 2007 and December 2008. Patients were assessed for theh presence of injuries conferring high risk for LEDVT, patient specific DVT risk factors, and low molecular weight heparin (LMWH) prophylaxis.

Dr. Azarbal noted that American College of Chest Physician (ACCP) guidelines stratify DVT risk in trauma patients based only on injury pattern and pharmacologic prophylaxis, and screening is only recommended for patients with high-risk injuries who are unable to receive pharmacologic prophylaxis.

“Given that current ACCP guidelines recommend treatment of CVDVTs, we investigated the efficacy of duplex ultrasound (DUS) screening in critically ill trauma patients for all LEDVTs,” he added. Forty asymptomatic patients in the study had LEDVTs (15.2 percent) that were diagnosed by DUS screening. Twenty-four of these patients (60 percent) had a CVDVT. Thirty percent of all DVT’s were diagnosed within one week of admission. Patients without high-risk injuries receiving LMWH had a 13 percent DVT rate, which did not differ significantly from the 19.7 percent DVT rate in high-risk injury patients not receiving LMWH.

“Current ACCP guidelines miss a substantial proportion of LEDVTs in critically ill trauma patients, especially when CVDVTs are included in the screening," said Dr. Azarbal. “Diagnosis of these otherwise undetected DVTs can lead to therapeutic anticoagulation, IVC filter placement or continued surveillance, depending on institutional practices.” “This study shows that DUS screening appears to be a useful adjunct to current protocols of DVT prevention, detection and treatment in trauma ICUs,” said researchers who recommend routine DUS, and early and ongoing surveillance of all critically ill trauma patients for all LEDVTs regardless of injury patterns, DVT risk factors, or the presence of pharmacologic prophylaxis.

About Journal of Vascular Surgery®Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery®. Visit the Journal Web site at http:www.jvascsurg.org/.

About the Society for Vascular SurgeryThe Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,350 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org® and follow SVS on Twitter by searching for VascularHealth or at http://twitter.com/VascularHealth.