Abstract 155: Elevated Risk of Venous Thromboembolism in Patients Undergoing Targeted Temperature Management After Cardiac Arrest

Abstract

Introduction: Therapeutic hypothermia (TH) reduces mortality and improves neurological outcomes after cardiac arrest. Cardiac arrest is considered a pro-thrombotic state. Endovascular cooling catheters may increase the risk of thrombosis. Therapeutic hypothermia (TH), however, increases fibrinolysis. These opposing effects may expose patients to both bleeding and venous thromboembolic risk during and after therapeutic hypothermia. The net effect in these patientsremains largely unexplored. Moreover, the exact rate of venous thromboembolism (VTE) is uncertain in these patients. We sought to determine the incidence and potential predictors of VTE in patients undergoing TH after cardiac arrest and compare it to a control group with similar risk of VTE. Methods: Single center retrospective analysis. Participants were age ≥18 years old, admitted to Hartford Hospital with out-of-hospital or in-hospital cardiac arrest, underwent TH between January 1, 2007 and April 30, 2019 with endovascular cooling catheter. A total of 562 patients who underwent TH (Study group) were compared to 304 matchedpatientstreated in the medical ICU with a diagnosis of ARDS (control group). This control group was based on presumed similarities in factors affecting VTE: intensive care setting, immobility, length of stay and likely presence of central venous catheters. Results: Patients who underwent TH had a significantly higher rate of VTE (6.6% vs 4.6%, p=0.006) and deep vein thrombosis (DVT) (2.3% vs 1.3%, p=0.011) when compared to control group. The rate of pulmonary embolism was higher in the TH group, but this was not statistically significant (2.5% and 1.0%, p=0.128). In multivariate analysis age, gender, race and hospital length of stay were not associated with development of VTE in the study group. Conclusion: Patients undergoing TH after cardiac arrest have statistically higher incidence of VTE and DVT compared to patients with ARDS. This risk is independent of age, gender, race or length of stay. Further research into additional independent predictors of VTE and DVT in this population may eventually guide the management and potential future interventions.