| Autor: |
Arabi, Yaseen M., Burns, Karen E. A., Alsolamy, Sami J., Alshahrani, Mohammed S., Al-Hameed, Fahad M., Arshad, Zia, Almaani, Mohammed, Hawa, Hassan, Mandourah, Yasser, Almekhlafi, Ghaleb A., Al Aithan, Abdulsalam, Khalid, Imran, Rifai, Jalal, Rasool, Gulam, Abdukahil, Sheryl Ann I., Jose, Jesna, Afesh, Lara Y., Al-Dawood, Abdulaziz, Saudi Critical Care Trials Group |
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| Zdroj: |
Intensive Care Medicine; Apr2020, Vol. 46 Issue 4, p737-746, 10p, 1 Diagram, 4 Charts |
| Abstrakt: |
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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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