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24.02.2020 | Original

Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial

verfasst von: Yaseen M. Arabi, Karen E. A. Burns, Sami J. Alsolamy, Mohammed S. Alshahrani, Fahad M. Al-Hameed, Zia Arshad, Mohammed Almaani, Hassan Hawa, Yasser Mandourah, Ghaleb A. Almekhlafi, Abdulsalam Al Aithan, Imran Khalid, Jalal Rifai, Gulam Rasool, Sheryl Ann I. Abdukahil, Jesna Jose, Lara Y. Afesh, Abdulaziz Al-Dawood, the Saudi Critical Care Trials Group

Erschienen in: Intensive Care Medicine | Ausgabe 4/2020

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Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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.

Trial registration

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.

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Titel: Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial
verfasst von: Yaseen M. Arabi
Karen E. A. Burns
Sami J. Alsolamy
Mohammed S. Alshahrani
Fahad M. Al-Hameed
Zia Arshad
Mohammed Almaani
Hassan Hawa
Yasser Mandourah
Ghaleb A. Almekhlafi
Abdulsalam Al Aithan
Imran Khalid
Jalal Rifai
Gulam Rasool
Sheryl Ann I. Abdukahil
Jesna Jose
Lara Y. Afesh
Abdulaziz Al-Dawood
the Saudi Critical Care Trials Group
Publikationsdatum: 24.02.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 4/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05899-1

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Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial