Why are critical care and COVID-19 patients vulnerable to VTE?

Every day in hospitals, patients in critical care typically present with multiple and rapidly changing venous thromboembolism (VTE) risk factors. This is in part due to their underlying risk factors, diagnosis, as well as medical interventions that may affect mobility, circulation and the tendency to clot. 

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Additionally, prolonged ICU stay, high APACHE score and mechanical ventilation are indicative of increased risk.1, 2 These heightened risk factors, among many others, may also be seen in critical patients diagnosed with COVID-19.

As stabilization is prioritized, early signs and symptoms of VTE may be masked and further obscured by other supportive interventions or disease processes. VTE can be difficult to diagnose and even extensive thrombi may be present, but remain undetected.3,4

With sub-optimal prophylaxis, the risk of VTE in ICU patients may be as high as 80%.5 In general, even with preventative measures, up to 15% of patients will be diagnosed with VTE, many during their first week of admission.6,7

To help minimize VTE risk in COVID-19 patients, current guidelines and consensus opinions recommend pharmacological prophylaxis in all COVID-19 patients, unless contraindicated. In those patients with contraindications, mechanical prophylaxis, such as intermittent pneumatic compression (IPC) devices, may be prescribed for those at risk.8 These devices augment blood flow in the deep veins of the legs, thereby reducing venous stasis, and enhance fibrinolytic activity to reduce the potential for clot formation.

Arjo's VTE prevention solutions, including the clinically effective Flowtron® Active Compression System and extensive, comfortable garment range, allow for physician preference to meet all clinical needs.

VTE prophylaxis is a vital component to help reduce the risk of clot formation and improve outcomes in critical care patients. Arjo is dedicated to preventing immobility-related complications in all patients and plays an important role in supporting our customers and your patients during this unprecedented time, today and everyday.

Author:  
Grace Hukushi, RN, BSN
Clinical Manager, VTE Prevention at Arjo 
 
 
Register for the Arjo educational webinar with Adj. Professor David Hardman, also featuring renowned expert and guest speaker,
Dr. Joseph A. Caprini, MD, MS, FACS, RVT, DFSVS, discussing
“COVID-19: The Tangled Hemostatic Web Revisited”

 


Reference: 

  1. Minet C, Potton L, Bonadona A et al. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophyalxis. Critical Care. 2015; 19: 287
  2. Adriance SM, Murphy CV. Prophylaxis and treatment of venous thromboembolism in the critically ill. Int J Crit Illn Inj Sci. 2013; 3: 143-151
  3. Mcleod AG, Geerts W. Venous Thromboembolism Prophylaxis in Critically Ill Patients. Crit Care Clin. 2011; 27: 765-780
  4. Geerts W, Code K & Jay RA. Prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994; 331: 1601-1606
  5. Attia J, Ray JG, Cook D et al. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001; 161: 1268-1279
  6. Duranteau J, Taccone FS, Verhamme P et al. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol. 2018; 35: 142-14
  7. Attia J, Ray JG, Cook D et al. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001; 161: 1268-1279
  8. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance V 1.2. March 13, 2020.