Prophylaxis and incidence of symptomatic deep vein thrombosis in indian patients with sepsis: DETECT-deep vein thrombosis registry

Sepsis, one of the oldest and most elusive syndromes, exhibits high mortality rates and is the most common cause of death among critically ill patients in noncoronary Intensive Care Units (ICUs). In a multicenter, prospective, observational study conducted in intensive therapy units in India, the incidence of severe sepsis was 13.1% of all admissions. psis leads to complications in coagulation and may manifest from mild alterations to severe disseminated intravascular coagulation. In sepsis, toxins activate coagulation directly through the effect of chemical mediators on endothelium and monocytes. In addition, pro-inflammatory cascade can result in indirect coagulation. Sepsis-induced procoagulant activity is more severe than that produced by trauma. Severe sepsis predisposes patients toward venous thromboembolism (VTE) due to risk factors such as advanced age, chronic cardiopulmonary disease, recent surgery, immobilization, in-dwelling vascular catheters, and previous VTE history. Thromboembolic complications contribute to the burden of severe sepsis and are observed in approximately one out of every 32 severe sepsis patients. e international guidelines recommend deep vein thrombosis (DVT) prophylaxis with either twice or thrice daily low-dose unfractionated heparin (UFH) or daily low molecular weight heparin (LMWH) in patients with severe sepsis unless contraindicated (i.e., thrombocytopenia, severe coagulopathy, Purpose: To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis. Materials and Methods: Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 7 days (if discharged before 30 days). Results: The study included 278 patients (men: 69.4%; mean age: 56.3 17.99 years). Out of 275 patients (data missing for 3 patients), 188 (68.4%; 95% confidence interval: 62.5-73.8) received DVT prophylaxis (185 at admission and 3 at discharge; pharmacological prophylaxis: n = 88, mechanical prophylaxis: n = 65, pharmacological + mechanical prophylaxis: n = 35) and 87 received no prophylaxis. In line with American College of Chest Physicians 2008 recommendations, among patients who received pharmacological prophylaxis (n = 123), low-molecular-weight heparin was given to 85.4% (n = 105) patients (duration: 9.1 6.36 days), unfractionated heparin to 12.2% (n = 15) patients (duration: 9.2 9.18 days), and fondaparinux to 5.7% (n = 7) patients (duration: 6.8 3.30 days); 27/63 patients at high-risk of bleeding received mechanical prophylaxis; no patient received aspirin. Of 9 patients who developed DVT, 7 received no thromboprophylaxis (data missing for 2 patients). In total, 186/274 (67.9%) patients recovered from sepsis. Conclusions: Two-third patients received thromboprophylaxis. The substantial role of thromboprophylaxis in DVT prevention mandates monitoring and control of thromboprophylaxis through internal audits in hospitals.