Incidence of deep vein thrombosis in neurointensive care unit patients-does prophylaxis modality makes any difference?

Abstract

Background and aims: To determine the incidence of upper and lower limb deep vein thrombosis (DVT) using ultrasonography (USG) in adult patients admitted to neuro-medical and neurosurgical intensive care unit (ICU). Subjects and methods: In this prospective observational study, patients admitted to the medical and surgical neuro ICU and remained in the ICU for more than 48 hours were recruited. All patients were clinically examined for DVT. Basilic and axillary veins in the upper limbs and popliteal and femoral veins in the lower limbs were screened for DVT using USG. USG examination was performed on the day of admission to ICU and thereafter every 3rd day till discharge from ICU or death. Intermittent pneumatic compression (IPC) stockings were applied to the lower limbs to all the patients in both ICUs. Unfractionated heparin (UFH) was given subcutaneously to neuro-medical ICU patients, while in surgical ICU, it was left to the discretion of the neurosurgeons. Results: A total of 130 adult patients were admitted to the ICU during the 8 month study period. Thirty patients were excluded and the remaining 98 patients' (38 in medical and 60 in surgical ICU) data were analyzed. None of the 38 medical ICU patients developed DVT, while in neurosurgical ICU, 4 out of 60 patients developed DVT. Conclusion: A combination of UFH andIPC stockings were effective in minimizing the DVT in neuro-medical ICU patients. In surgical patients, through IPC stockings were effective, UFH can be considered for patients with intracranial malignancy.