Venous Thromboembolism in Neurocritical Care Patients

Authors

Tanuwong Viarasilpa, Henry Ford HealthFollow
Nicha Panyavachiraporn, Henry Ford HealthFollow
Jack Jordan, Henry Ford HealthFollow
Seyed M. Marashi, Henry Ford HealthFollow
Meredith Van Harn, Henry Ford HealthFollow
Noel O. Akioyamen, Henry Ford HealthFollow
Robert G. Kowalski, Henry Ford HealthFollow
Stephan A. Mayer, Henry Ford HealthFollow

Recommended Citation

Viarasilpa T, Panyavachiraporn N, Jordan J, Marashi SM, van Harn M, Akioyamen NO, Kowalski RG, and Mayer SA. Venous Thromboembolism in Neurocritical Care Patients. J Intensive Care Med 2019; Epub ahead of print.

Document Type

Article

Publication Date

5-7-2019

Publication Title

Journal of intensive care medicine

Abstract

BACKGROUND: Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients.

METHODS: We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation-perfusion scan >24 hours after admission. Patients with ICU length of stayexcluded.

RESULTS: Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, P = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P = .007).

CONCLUSIONS: Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.

PubMed ID

31060441