Clinical characteristics & outcome of upper body deep vein thrombosis in critically ill patients

Background & objectives The incidence, risk factors and outcomes of upper body deep vein thrombosis (DVT) is less well studied in critically ill patients. This study aimed to estimate the incidence and identify the risk factors for the development of upper body-DVT. Secondary objectives included evaluating the anatomical sites of DVT, the impact of thromboprophylaxis, and short-term outcomes. Methods In this prospective observational cohort study, patients admitted to the intensive care unit (ICU) between December 2021 and December 2022 were screened for DVT using duplex ultrasonography at 48 h, 7, 14, 21, and 28 days after admission. Results Among 241 participants, 39 (16.2%) developed upper body DVT and 8 (3.3%) had lower limb DVT. The internal jugular vein was the most frequent site of DVT. Multivariable analysis identified platelet transfusion [Odds ratio (OR)=19.4; 95% Confidence interval (CI): 4.4-86.1], platelet count (OR=1.007; 95% CI: 1.002-1.011), duration of central venous catheter use (OR= 1.2; 95% CI: 1.1-1.3), and number of dialysis sessions (OR= 1.15; 95% CI: 1.01-1.3) as independent risk factors for upper body DVT. Participants with upper body DVT had significantly longer ICU stay (41 vs. 8 days) and duration of mechanical ventilation (33 vs. 5 days). However, ICU mortality was similar in those with or without DVT (48.7% vs. 44.3%). Interpretation & conclusions Upper body DVT occurred more frequently than lower limb DVT, with internal jugular vein being the most common site. Platelet transfusion, higher platelet counts, prolonged catheter use, and increased dialysis sessions were associated with increased risk of upper body DVT. Upper body DVT was also linked to prolonged ICU stay and increased ventilation days but not increased mortality.