Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients
Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2012-01-01
|
| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/489135 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832548731665252352 |
|---|---|
| author | Michael Blaivas Konstantinos Stefanidis Serafim Nanas John Poularas Mitchell Wachtel Rubin Cohen Dimitrios Karakitsos |
| author_facet | Michael Blaivas Konstantinos Stefanidis Serafim Nanas John Poularas Mitchell Wachtel Rubin Cohen Dimitrios Karakitsos |
| author_sort | Michael Blaivas |
| collection | DOAJ |
| description | Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers. Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716, P=0.007)], malignancy (OR 1.483, P=0.036), total parenteral nutrition (OR 1.399, P=0.035), hypercoagulable state (OR 1.284, P=0.045), and obesity (OR 1.191, P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined. Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low. |
| format | Article |
| id | doaj-art-6d64ad9bfe4c4770acc71c8d9ef1a2da |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-6d64ad9bfe4c4770acc71c8d9ef1a2da2025-02-03T06:13:14ZengWileyCritical Care Research and Practice2090-13052090-13132012-01-01201210.1155/2012/489135489135Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care PatientsMichael Blaivas0Konstantinos Stefanidis1Serafim Nanas2John Poularas3Mitchell Wachtel4Rubin Cohen5Dimitrios Karakitsos6Department of Emergency Medicine, North Side Hospital Forsyth, Cumming, GA 30041, USARadiology and 1st Critical Care Departments, Evangelismos University Hospital, 10676 Athens, GreeceRadiology and 1st Critical Care Departments, Evangelismos University Hospital, 10676 Athens, GreeceIntensive Care Unit, General State Hospital of Athens, 10676 Athens, GreeceDepartment of Biostatistics, Texas Tech University, Lubbock, TX 79409, USADivision of Pulmonary and Critical Care Medicine, Hofstra North Shore-LIJ School of Medicine, The Long Island Jewish Medical Center, New York, NY 11549, USAIntensive Care Unit, General State Hospital of Athens, 10676 Athens, GreeceBackground-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers. Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716, P=0.007)], malignancy (OR 1.483, P=0.036), total parenteral nutrition (OR 1.399, P=0.035), hypercoagulable state (OR 1.284, P=0.045), and obesity (OR 1.191, P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined. Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.http://dx.doi.org/10.1155/2012/489135 |
| spellingShingle | Michael Blaivas Konstantinos Stefanidis Serafim Nanas John Poularas Mitchell Wachtel Rubin Cohen Dimitrios Karakitsos Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients Critical Care Research and Practice |
| title | Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients |
| title_full | Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients |
| title_fullStr | Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients |
| title_full_unstemmed | Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients |
| title_short | Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients |
| title_sort | sonographic and clinical features of upper extremity deep venous thrombosis in critical care patients |
| url | http://dx.doi.org/10.1155/2012/489135 |
| work_keys_str_mv | AT michaelblaivas sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT konstantinosstefanidis sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT serafimnanas sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT johnpoularas sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT mitchellwachtel sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT rubincohen sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients AT dimitrioskarakitsos sonographicandclinicalfeaturesofupperextremitydeepvenousthrombosisincriticalcarepatients |