Journal
CRITICAL CARE MEDICINE
Volume 50, Issue 4, Pages E370-E381Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000005382
Keywords
critical care; prognostic; venous thromboembolism
Categories
Funding
- Hamilton Health Sciences New Investigator Grant
- Canada Research Chair in Critical Care Knowledge Translation
- Leo Pharma Chair in Thromboembolism Research at McMaster University
- Novartis
- Tier 2 Research Chair in Thrombosis and Anticoagulation Safety from the University of Ottawa
- Heart and Stroke Foundation of Canada National New Investigator Award
- Academy, BMS/Pfizer Alliance
- Amag Pharmaceuticals
- Tier 1 Research Chair in Venous Thrombosis and Cancer from the Department of Medicine at the University of Ottawa
- BMS
- Leo Pharma
- Pfizer
- Valeo
- Edwards LifeSciences
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This study aims to identify prognostic factors for the development of venous thromboembolism in the ICU. The results show that factors associated with an increased risk of venous thromboembolism include older age, obesity, active malignancy, history of venous thromboembolism, history of recent surgery, sepsis, lack of pharmacologic prophylaxis, central venous catheter, invasive mechanical ventilation, and use of vasoactive medication.
OBJECTIVE: To identify prognostic factors for the development of venous thromboembolism in the ICU. DATA SOURCES: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to March 1, 2021. STUDY SELECTION: We included English-language studies describing prognostic factors associated with the development of venous thromboembolism among critically ill patients. DATA EXTRACTION: Two authors performed data extraction and risk-of-bias assessment. We pooled adjusted odds ratios and adjusted hazard ratios for prognostic factors using random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. DATA SYNTHESIS: We included 39 observational cohort studies involving 729,477 patients. Patient factors with high or moderate certainty of association with increased odds of venous thromboembolism include older age (adjusted odds ratio, 1.15; 95% CI, 1.02-1.29 per 10 yr), obesity (adjusted odds ratio, 1.25; 95% CI, 1.18-1.32), active malignancy (adjusted odds ratio, 1.70; 95% CI, 1.18-2.44), history of venous thromboembolism (adjusted odds ratio, 4.77; 95% CI, 3.42-6.65), and history of recent surgery (adjusted odds ratio, 1.77; 95% CI, 1.26-2.47). ICU-specific factors with high or moderate certainty of association with increased risk of venous thromboembolism include sepsis (adjusted odds ratio, 1.41; 95% CI, 1.12-1.78), lack of pharmacologic venous thromboembolism prophylaxis (adjusted odds ratio, 1.80; 95% CI, 1.14-2.84), central venous catheter (adjusted odds ratio, 2.93; 95% CI, 1.98-4.34), invasive mechanical ventilation (adjusted odds ratio, 1.74; 95% CI, 1.36-2.24), and use of vasoactive medication (adjusted odds ratio, 1.86; 95% CI, 1.23-2.81). CONCLUSIONS: This meta-analysis provides quantitative summaries of the association between patient-specific and ICU-related prognostic factors and the risk of venous thromboembolism in the ICU. These findings provide the foundation for the development of a venous thromboembolism risk stratification tool for critically ill patients.
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