EVALUATION OF COMPLICATIONS ASSOCIATED WITH SYMPTOMATIC THROMBOSIS INDUCED BY CENTRAL VENOUS CATHETERS IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Catheter-related venous thrombosis (CRVT), Central venous catheter (CVC), Intensive care unit (ICU), Venous thromboembolism (VTE), Risk factors
Abstract
Background: Catheter-related venous thrombosis (CRVT) is a significant complication among critically ill patients receiving central venous catheters (CVCs) in intensive care units (ICUs). Despite extensive research on venous thromboembolism (VTE), there remains limited understanding of disease-related risk factors specific to symptomatic CRVT in ICU patients. Objective: This study aims to identify independent clinical risk factors associated with symptomatic CRVT in ICU patients with CVCs. Methods: A retrospective cohort study was conducted with a total of 150 patients with CVCs were included, with 25 developing symptomatic CRVT. Patient data, including demographics, clinical history, ICU stay duration, intubation time, CVC dwell time, and anticoagulation status, were analyzed. Logistic regression models were used to identify independent risk factors for symptomatic CRVT. Results: The overall incidence of symptomatic CRVT was 16.7%. Major clinical risk factors identified were trauma (OR: 1.595; 95% CI: 1.073–2.448; p = 0.033), major surgery (OR: 1.943; 95% CI: 1.334–2.586; p = 0.013), and myocardial infarction (OR: 2.98; 95% CI: 1.142–2.401; p = 0.019). Prolonged ICU stay, extended intubation duration, and longer CVC indwelling times were significantly associated with symptomatic CRVT (p < 0.001). Additionally, patients with symptomatic CRVT had higher APACHE II scores and more frequent anticoagulant contraindications. Conclusions: Trauma, major surgery, and myocardial infarction are significant independent predictors of symptomatic CRVT in ICU patients with CVCs. Prolonged intubation, extended CVC dwell times, and limited anticoagulant therapy further increase the risk. Early identification of high-risk patients and implementation of targeted preventive strategies, including individualized anticoagulation protocols, are essential to reduce CRVT incidence in ICU settings. Future multi-center studies are recommended to validate these findings and inform comprehensive thromboprophylaxis guidelines.
References
2. Lamontagne F, McIntyre L, Dodek P, et al. Nonleg venous thrombosis in critically ill adults: a nested prospective cohort study. JAMA Intern Med 174, 2014, 689–96.
3. Malato A, Dentali F, Siragusa S, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus 13, 2015, 559–68.
4. Cohoon KP, Leibson CL, Ransom JE, et al. Direct medical costs attributable to venous thromboembolism among persons hospitalized for major operation: a population-based longitudinal study. Surgery 157, 2015, 423–31.
5. Winters JP, Callas PW, Cushman M, Repp AB, Zakai NA, et al. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. J Thromb Haemost 13, 2015, 2155–60.
6. Parienti JJ, Mongardon N, Megarbane B, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med 373, 2015, 1220–9.
7. Hrdy O, Strazevska E, Suk P, et al. Central venous catheter-related thrombosis in intensive care patients—incidence and risk factors: A prospective observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 161, 2017, 369–73.
8. Antonelli M, De Pascale G, Ranieri VM, et al. Comparison of triple-lumen central venous catheters impregnated with silver nanoparticles (AgTive(R)) vs conventional catheters in intensive care unit patients. J Hosp Infect 82, 2012, 101–7.
9. Malinoski D, Ewing T, Bhakta A, et al. Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis. J Trauma Acute Care Surg 74, 2013, 454–62.
10. Meizoso JP, Karcutskie CA, Ray JJ, et al. A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. J Surg Res 207, 2017, 138–44.
11. Park MS, Perkins SE, Spears GM, et al. Risk factors for venous thromboembolism after acute trauma: a population-based case-cohort study. Thromb Res 144, 2016, 40–5.
12. Geerts WH, Code K, Jay RM, Chen E, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med 331, 1994, 1601–6.
13. Moore HB, Moore EE, Liras IN, et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients. J Am Coll Surg 222, 2016, 347–55.
14. Engelman DT, Gabram SG, Allen L, Ens GE, Jacobs LM. Hypercoagulability following multiple trauma. World J Surg 20, 1996, 05–10.
15. McCully BH, Connelly CR, Fair KA, et al. Onset of coagulation function recovery is delayed in severely injured trauma patients with venous thromboembolism. J Am Coll Surg 225, 2017, 42–51.
16. Hamada SR, Espina C, Guedj T, et al. High level of venous thromboembolism in critically ill trauma patients despite early and well-driven thromboprophylaxis protocol. Ann Intensive Care 7, 2017, 97.
17. Jacobs BN, Cain-Nielsen AH, Jakubus JL, et al. Unfractionated heparin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in trauma. J Trauma Acute Care Surg 83, 2017, 151–8.
18. Yhim HY, Jang MJ, Bang SM, et al. Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 12, 2014, 1035–43.
19. Rogers SO, Jr, Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF, et al. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204, 2007, 1211–21.
20. Vachirasrisirikul S & Laohapensang K. Incidence and risk factors of venous thromboembolism following major abdominal surgery. J Med Assoc Thai 99, 2016, 665–74.
21. Alberts BD, Woldu SL, Weinberg AC, Danzig MR, Korets R, Badani KK, et al. Venous thromboembolism after major urologic oncology surgery: a focus on the incidence and timing of thromboembolic events after 27,455 operations. Urology 84, 2014, 799–806.
22. Trinh VQ, Karakiewicz PI, Sammon J, et al. Venous thromboembolism after major cancer surgery: temporal trends and patterns of care. JAMA Surg 149, 2014, 43–9.
23. Wilson TJ, Brown DL, Meurer WJ, Stetler WR, Jr, Wilkinson DA, Fletcher JJ, et al. Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients. Intensive Care Med 38, 2012, 272–8.
24. Lip GY, Gibbs CR. Does heart failure confer a hypercoagulable state? Virchow's triad revisited. J Am Coll Cardiol 33, 1999, 1424–6.
25. Alikhan R, Spyropoulos AC. Epidemiology of venous thromboembolism in cardiorespiratory and infectious disease. Am J Med 121, 2008, 935–42.
26. Kaplan D, Casper TC, Elliott CG, et al. VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest 148, 2015, 1224–30.
27. Leung A, Heal C, Perera M, Pretorius C, et al. A systematic review of patient-related risk factors for catheter-related thrombosis. J Thromb Thrombolysis 40, 2015, 363–73
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Soundara Rajan
Assistant Professor, Department of General Surgery, Sri Lakshmi Narayana Institute of Medical Sciences & Hospital, Osudu, Puducherry – 605502