Risk stratification, prevalence by hand-held microdoppler and in-hospital mortality of deep venous thrombosis in indoor geriatric population.

OBJECTIVE To screen indoor geriatric patients for deep venous thrombosis (DVT) risk, assess them for the presence of DVT with hand-held microdoppler (HHMD) and correlate DVT risk score with inpatient mortality. METHODS 111 patients (> or = 60 years) admitted for > or = 72 hours [51 patients from intensive care unit (ICU) and 60 patients from general medical wards (GMW)] over 15 months were included. Patients with suspected venous thromboembolic disease on admission were excluded. On admission, patients were screened with HHMD for the presence of DVT; those with evidence of lower limb DVT were excluded. DVT risk was stratified using the SMART Tool and patients classified into mild (1), moderate (2), high (3-4) and very high (> or = 5) risk groups. Patients were screened periodically clinically and with HHMD for DVT till discharge. The effect of thromboprophylaxis (heparin) on all-cause mortality was correlated. Levene's test for equality of variances and Pearson's Chi-square test were used for statistical analysis. RESULTS Mean risk score (SMART TOOL) in study group was 5.15. Among 111 patients, 75 (67.56%) had high to very high risk for DVT. Immobilization, sepsis, heart failure, and acute coronary syndrome were most common risk factors for DVT. Only 2.7% of indoor geriatric patients had clinical evidence of DVT while 13.5% had presumptive evidence of DVT as detected by HHMD. The mean risk score for DVT in expired patients was higher than in discharged patients (p = 0.052). ICU patients receiving thromboprophylaxis had significantly lower mortality (9.5%) compared to those who did not (50%). (p = 0.004). Patients with presumptive evidence of DVT on HHMD had significantly higher mortality (53.33 percent) compared to those without evidence of DVT (15.62 percent); p < 0.05. CONCLUSIONS Indoor geriatric patients constitute high risk group for DVT. There could be an increased risk of mortality in patients with presumptive evidence of DVT on HHMD.