Prevalence of Venous Thromboembolic Disease in ICU Gabriel Toure University Hospital ()
1. Introduction
Venous thromboembolic disease (VTE) is a nosological group that mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Indeed, between 70% and 80% of PEs are complications of deep vein thrombosis of the lower limbs [1]. The incidences are quite inhomogeneous between these different countries, ranging from 0.48 to 1.60 events/1000; they vary with age and can reach 5/1000 after 75 years [2]. In studies conducted in Benin, Cameroon, Ivory Coast and Mali, the hospital prevalence was 8.3%; 1.6%; 0.95%; 4.95% [3]-[6]. The often difficult diagnosis, the significant morbidity and mortality with medium and long-term sequelae make it a public health problem. This led us to initiate this work which aimed to determine the prevalence of VTE and to identify the different risk factors (FDR) responsible for thromboembolic events in patients in the Intensive Care Unit.
2. Patients and Methods
This is a descriptive study over a period of 1 year with prospective data collection from May 1, 2023 to April 30, 2024. This study took place in the Intensive Care Unit of the Gabriel Toure University Hospital in Bamako and covered all the files of patients of both sexes and all ages hospitalized for the managment of a medical or surgical pathology.
2.1. Inclusion Criteria
The study included all patients, regardless of age and sex, who presented: For deep vein thrombosis (DVT), suggestive clinical signs (redness, edema, pain in the leg or calf) and confirmed by venous Doppler ultrasound of the lower limbs; For pulmonary embolism (PE), suggestive clinical signs (tachypnea, tachycardia, chest pain, and, in more severe cases, hypotension) confirmed by spiral CT angiography; Patients were included if these signs were present upon admission or developed during their hospitalization.
2.2. Non-Inclusion Criteria
Patients who presented clinical signs suggestive of deep vein thrombosis (DVT) (redness, edema, pain in the leg or calf) and whose Doppler ultrasound of the limb vessels returned normal were not included in the study; for pulmonary embolism (PE), patients who presented signs (tachypnea, tachycardia, chest pain and, in more severe cases, hypotension) but whose spiral CT angiography returned normal.
2.3. Operational Definition
Tachycardia was defined as a heart rate greater than 100 beats per minute.
Polypnea was defined as a respiratory rate greater than 20 cycles per minute.
Lower limb edema (LLE) is an increase in the volume of one or both legs, in part or in whole.
We considered confirmed cases of lower limb venous thrombosis to be: patients who presented clinical signs suggesting lower limb thrombosis with confirmation by ultrasound of the limb vessels.
We considered as confirmed cases of pulmonary embolism patients with positive CT angiography confirming pulmonary embolism.
2.4. Data Collection and Processing
Data were collected from survey forms and medical records. Data collection and analysis were conducted using SPSS version 25.0 software. Tabulation was performed using Microsoft Office Excel 2016. Word processing was performed using Microsoft Office Word 2016.
2.5. Ethical Considerations
We have requested and obtained patient consent and/or the assent of their companions and dependents, and we have guaranteed the confidentiality of the information collected.
3. Results
We admitted 627 patients, including 6 cases of venous thromboembolic disease (VTE), giving an overall hospital prevalence of 0.96% and a specific prevalence of isolated pulmonary embolism (PE) and the association of pulmonary embolism (PE) and deep vein thrombosis (DVT) were 0.64% and 0.16%, respectively. The mean age was 49.67 ± 17.58 years, ranging from 30 to 71 years, and the sex ratio was 0.2 (Figure 1), with a female predominance. Housewives accounted for 33.3%.
The transient risk factors were prolonged immobilization ≥ 05 days (05 cases) 83.3%, major general surgery (01 case) 16.7%, spinal cord injury (01 case) 16.7%, central venous catheter (04 cases) 66.6% including 03 approaches in the femoral position. The permanent risk factors were obesity (04 cases) 66.6%, age (3 cases) 50%, high blood pressure (HTA) (3 cases) 50%, cancer (01 case) 16.7% (Table 1).
The main clinical signs were dyspnea 100%, tachycardia 33.3% and chest pain 33.3%, Homans sign + increased local heat (01 case) 16.7% (Table 2).
The diagnoses retained were pulmonary embolism (PE) alone (04 cases) 83.3%, deep vein thrombosis (DVT) alone (01 case) 16.7% and the association PE + DVT
Figure 1. Distribution by gender.
Table 1. Distribution according to risk factors.
Risk factors |
Workforce |
Percentage (%) |
Transients |
|
Prolonged immobilization ≥ 5 days |
5 |
83.3 |
Major general surgery |
1 |
16.7 |
Spinal cord injury |
1 |
16.7 |
Permanent |
|
Diabetes |
1 |
16.7 |
Obesity |
4 |
66.6 |
Age ≥ 55 years |
3 |
50 |
History of stroke |
1 |
16.7 |
high blood pressure |
3 |
50 |
Cancer |
1 |
16.7 |
Acquired in intensive care |
|
Mechanical ventilation |
4 |
66.6 |
Central venous catheter |
4 |
66.6 |
Vasopressor treatment |
2 |
33.3 |
Table 2. Distribution according to clinical signs.
Clinical signs |
Workforce |
Percentage (%) |
Deep vein thrombosis (DVT) |
|
Homans Sign + Increase in Local Heat |
1 |
50 |
One-sided IMO |
1 |
50 |
Pulmonary embolism (PE) |
|
Chest pain |
2 |
33.3 |
Polypnea |
5 |
100 |
Tachycardia |
2 |
33.3 |
(01 case) 16.7% (Figure 2).
On imaging, the obstruction of the pulmonary artery was bilateral in (03 cases) 60% (Table 3).
Figure 2. Patient distribution by lesion type.
Table 3. Distribution according to the location of the thrombus on CT angiography.
Thrombus location on CT angiography |
Workforce |
Percentage (%) |
Proximal pulmonary arteries |
1 |
20 |
Bilateral obstruction |
3 |
60 |
Branches of subsegmental divisions of the AP arteries |
1 |
20 |
Total |
5 |
100 |
Table 4. Distribution according to the evolution according to the PESI score.
sPESI |
Evolution under treatment |
Total |
Favorable |
unfavorable |
1 |
1 |
1 |
2 |
2 |
0 |
1 |
1 |
3 |
1 |
0 |
1 |
4 |
0 |
1 |
1 |
Total |
2 |
3 |
5 |
In addition to general resuscitation measures, all patients were placed on simple oxygen therapy with a simple mask. High-flow oxygenation (HFO) was initiated in (02 cases) and 02 patients were intubated and ventilated. Vasopressor amines such as dobutamine + noradrenaline and noradrenaline alone were initiated in (02 cases). For anticoagulant treatment, 83.3% of patients were placed on direct oral anticoagulants (DOACs) and 16.7% on low molecular weight heparin (LMWH). The average length of stay was 7.3 ± 3.33 days with extremes of 4 to 13 days and the case fatality of (03 cases) 50% of which (02 cases) 66.67% had sPESI ≥ 2 (Table 4).
4. Discussion
The prevalence of venous thromboembolic disease was 0.96% this result is close to that of Bertrand et al. [5] in Ivory Coast 0.95% and is lower than those of Denakpo et al. in Benin [3] 8.3%, Owono Etoundi et al. [4] in Cameroon 1.6%, Coulibaly et al. [6] in Mali 4.95%; our result can be explained by the fact that the diagnosis of (PE) is difficult despite the progress of diagnostic means, these difficulties are reported in the literature found in the literature [7] [8]. The average age of the patients was 49.67 ± 17.58 years this result is close to that by Owono Etoundi et al. [4] in Cameroon, Coulibaly et al. and Menta et al. [9] in Mali who found respectively 50.61 ± 25 years, 54 ± 17.79 years and 46.46 ± 21 years. The incidence of venous thromboembolic events increases with age, which is an independent thromboembolic risk factor. This risk is all the more important as there is an increased incidence of associated comorbidities (surgical interventions, immobility, or cancer) with age [10]. The sex ratio of 0.2 with a female predominance is found in studies [4] [6] [11] [12].
Prolonged bed rest was the most frequently found risk factor 83.3% followed by central venous catheter 66.6% and obesity 66.6%. Obesity and prolonged bed rest are found in the literature as risk factors for VTE [13]-[15]. The predominant clinical manifestations of DVT were inflammatory edema associated with positive Homans sign 50% this result is close to that of Menta et al. in Mali [9] the literature confirms that edema of the lower limbs is the sign of DVT [16]. Dyspnea was the symptom of PE 100% of cases this result is similar to Coulibaly et al. in Mali [6]. The diagnoses retained were pulmonary embolism alone 83.3%, pulmonary embolism and deep vein thrombosis 16.7% and deep vein thrombosis alone 16.7%. The anticoagulant treatment was based on direct oral anticoagulants (DOAC) 83.3% mainly in accordance with the recommendations of the literature [16] [17]. The average length of stay 7.3 ± 3.3 days with extremes of 4 to 13 days, mortality of (03 cases) 50%, of which (02 cases) 66.67% had sPESI ≥ 2 this relationship PESI score.
5. Conclusion
The diagnosis and management of venous thromboembolic disease remains difficult. The female sex was the most affected, with prolonged bed rest as the main risk factor. The evolution remains marked by a significant morbidity mortality.