PREVALENCE OF DEEP VENOUS THROMBOSIS AMONG PATIENTS IN MEDICAL INTENSIVE GALE

Objective.-To determine the frequency of deep venous thrombosis (DVT) in medical intensive care unit (MICU) patients. Design.-Prospective ul trasound case series. Setting.-An MICU in a large tertiary care hospit al in Boston, Mass. Subjects.-Patients older than 18 years of age admi tted to the MICU with an anticipated stay of more than 48 hours. Main Outcome Measure.-Deep venous thrombosis as detected by ultrasonography with color Doppler imaging performed twice weekly in the MICU and onc e within 1 week of discharge from the MICU. Results.-Deep venous throm bosis was detected in 33% (95% confidence interval, 24% to 43%) of 100 eligible patients during the 8-month study period. Forty-eight percen t (16/33) were proximal lower extremity DVT, and 15% (5/33) were upper extremity DVT associated with central venous catheters, with one pati ent having both upper and proximal lower extremity DVT. Ultrasound exa mination results led to inferior vena cava filter placement in three p atients, initiation of full-dose anticoagulation in four patients, ini tiation or continuation of low-dose subcutaneous heparin in 10 patient s, follow-up ultrasound studies in three patients, central line remova l in one patient, and no intervention in 10 patients due to active ble eding, prior filter, or heparin-induced thrombocytopenia. Two patients remained anticoagulated for other reasons. In this series, there was no difference in age, gender, body mass index, diagnosis of cancer, re cent surgery, duration of hospitalization prior to DVT detection, and DVT prophylaxis between patients with DVT and those without. Conclusio ns.-An unexpectedly high rate of DVT was detected by ultrasound in the se MICU patients despite prophylaxis in 61%. Traditionally recognized DVT risk factors failed to identify patients who developed DVT. Routin e ultrasound surveillance or more intensive prophylaxis regimens may b e warranted in this patient population if these DVT rates are confirme d in other settings.