Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial

Giordano Tini, Amanda Moriconi, Stefano Ministrini, Valentina Zullo, Elisa Venanzi, Giulia Mondovecchio, Tommaso Campanella, Ettore Marini, Maura Bianchi, Federico Carbone, Matteo Pirro, Edoardo De Robertis, Leonella Pasqualini, Giordano Tini, Amanda Moriconi, Stefano Ministrini, Valentina Zullo, Elisa Venanzi, Giulia Mondovecchio, Tommaso Campanella, Ettore Marini, Maura Bianchi, Federico Carbone, Matteo Pirro, Edoardo De Robertis, Leonella Pasqualini

Abstract

Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.

Keywords: Color-Doppler ultrasound; Critically ill patients; Deep vein thrombosis; Intensive care; Venous thromboembolism prophylaxis.

Conflict of interest statement

None of the Authors declare any conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
A Number of color-Doppler ultrasound (CDU) examinations of lower limbs performed in the two groups of subjects. B Prevalence of deep vein thrombosis (DVT) in the two group of subjects. C Results of the first color-Doppler ultrasound examinations in screening and non-screening group. D Prevalence of extending thrombosis in the two groups
Fig. 2
Fig. 2
A Prevalence of pharmacological antithrombotic treatment in the two groups. B Type of pharmacological treatment and relative dosage in the two groups.P C Therapeutic modifications during the stay in intensive care unit (ICU) in the two groups. D Concordance of the ultrasound diagnosis of deep vein thrombosis (DVT) and the associated pharmacological treatment in the two groups.  E Overall duration of the pharmacological antithrombotic treatment during the stay in ICU, in the two groups. F Time between the admission and the initiation of antithrombotic pharmacological treatment in the two groups. LMWH: low-molecular weight heparin
Fig. 3
Fig. 3
A Incidence of clinically relevant anemia in the two groups. B Incidence of clinically relevant anemia in patients treated and not treated with antithrombotic drugs. C Risk of death during the stay in Intensive Care Unit (ICU) in the two groups. D Duration of stay in the ICU in the two groups

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