From fb65b97a9212d9b5950458d77e0c5973c0f972f5 Mon Sep 17 00:00:00 2001 From: Sebastian Gibb Date: Thu, 4 Jan 2024 22:45:02 +0100 Subject: [PATCH] chore: update index.html --- index.html | 730 +++++++++++++++++++++++++++-------------------------- 1 file changed, 376 insertions(+), 354 deletions(-) diff --git a/index.html b/index.html index c27be45..fa8a30d 100644 --- a/index.html +++ b/index.html @@ -387,21 +387,27 @@

Sebastian Gibb, MD1,✉, Sebastian Engelhardt
This manuscript is work-in-progress!
Please find details at https://github.com/umg-minai/crt.
-Manuscript date: 2023-12-29 12:14; Version: d95f7f5 +Manuscript date: 2024-01-04 22:45; Version: 4d1bde8

Abstract

-

Background: +

Objective: Catheter-related thrombosis (CRT) is a major complication of central venous catheters (CVCs). However, the incidence, onset, and dependence of CRT on CVC material and/or type in critically ill surgical patients is unknown. Therefore, we here investigated incidence, onset, and dependence of CRT on a variety of risk factors including CVC material and type in critically ill surgical patients.

-

Methods: -In this prospective observational single-center study we included all critically ill patients with CVCs that were treated in our surgical intensive care unit during a six-month period. +

Design: +Prospective, investigator-initiated, observational study.

+

Setting: +A surgical ICU at an university hospital.

+

Patients +All critically ill patients with CVCs that were treated in our surgical ICU during a six-month period.

+

Interventions: +None.

+

Measurements and Main Results: All CVCs were examined for CRT every other day using ultrasound, starting within 24 hours of placement. The primary outcome was the time of onset of CRT depending on the type of CVC. CRT risk factors were analyzed using multiple Cox proportional hazards regression models.

-

Results: -We included 95 first-time CVCs in the internal jugular vein. +

We included 95 first-time CVCs in the internal jugular vein. The median time to CRT varied from one day to five days for different types of CVCs. Within one day, 37 to 64% of CVCs @@ -412,7 +418,7 @@

Sebastian Gibb, MD1,✉, Sebastian Engelhardt Almost all CVCs in critically ill surgical patients developed an asymptomatic CRT in the first days after catheterization. Depending on the type of CVC the median CRT-free period varied considerably.

Keywords: -Central venous catheter, Catheter-related thrombosis, Ultrasound, Intensive care medicine

+Central Venous Catheters, Venous Thrombosis, Ultrasonography, Perioperative Care, Critical Illness

@@ -420,23 +426,23 @@

Sebastian Gibb, MD1,✉, Sebastian Engelhardt

1 Department of Anesthesiology and Intensive Care Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475 Greifswald, Germany.

✉ Correspondence: Sebastian Gibb, MD <>

-
-

Background

-

Central venous catheters (CVCs) are commonly used during surgery and in critically ill patients [1]. +

+

Introduction

+

Central venous catheters (CVCs) are commonly used during surgery and in critically ill patients (1). Catheter-related thrombosis (CRT) is a major complication of central venous access and an important risk factor for pulmonary embolism (PE) and -central line-associated bloodstream infections (CLABSI)[1,2].

+central line-associated bloodstream infections (CLABSI)(1, 2).

The majority of CRTs are asymptomatic and patients with CVCs are rarely screened for CRT in routine clinical practice. -The incidence of CRT in previous studies varies widely between medical and surgical patients, ranging from 6 to 56% [2–6]. -A recently published study used a daily ultrasound assessment on mostly critically ill medical patients and found a median time to CRT of four days with an incidence of 16.9% [4]. +The incidence of CRT in previous studies varies widely between medical and surgical patients, ranging from 6 to 56% (2–6). +A recently published study used a daily ultrasound assessment on mostly critically ill medical patients and found a median time to CRT of four days with an incidence of 16.9% (4). Perioperative hypercoagulability in surgical patients may explain the higher incidence of CRT with more than 50%. However, despite the much higher incidence the onset of CRT in surgical patients is still unknown.

-

Patient-related risk factors for CRT, such as cancer or previous vein thrombosis, are well-known [1,7]. +

Patient-related risk factors for CRT, such as cancer or previous vein thrombosis, are well-known (1, 7). In contrast, catheter-related risk factors other than insertion site and catheter diameter have rarely been studied. -Only one small study, almost 30 years old, looked at the effect of catheter material and found a lower incidence of CRT for polyurethane/siliconized catheters compared with polyvinyl chloride/polyethylene [8].

+Only one small study, almost 30 years old, looked at the effect of catheter material and found a lower incidence of CRT for polyurethane/siliconized catheters compared with polyvinyl chloride/polyethylene (8).

Therefore, we conducted a prospective observational single-center study to determine the incidence, onset, and dependence of CRT on CVC material and/or manufacturer in postoperative critically ill patients.

-
-

Methods

+
+

Material and Methods

Study design and population

In this prospective observational single-center study, we evaluated the occurrence of CRT in critically ill patients with CVCs treated in our surgical intensive care unit (ICU) @@ -485,21 +491,21 @@

Outcome

Statistical analysis

All data processing and all statistical analyses were performed using R version 4.3.1 -[9].

+(9).

Prior to the analyses, all laboratory values were log transformed to approximate normal distributions. -CRT-free time was modelled using Kaplan-Meier estimates, and comparisons between different CVC types were made using the Gehan-Wilcoxon test with the Peto and Peto modification for different censoring patterns as implemented in the survival R package [10,11]. +CRT-free time was modelled using Kaplan-Meier estimates, and comparisons between different CVC types were made using the Gehan-Wilcoxon test with the Peto and Peto modification for different censoring patterns as implemented in the survival R package (10, 11). Multivariable Cox proportional hazards regression models were used to estimate hazard ratios of CRT -as provided by the survival R package [10–12]. -Adjustment was done for sex, CVC type, side, admission type, perioperative placement, sepsis, cancer, previous deep vein thrombosis (DVT), and anticoagulation. +as provided by the survival R package (10–12). +Adjustment was done for sex, CVC type, side, admission type, perioperative placement, sepsis, cancer, previous deep vein, thrombosis (DVT), and anticoagulation. The proportional hazard assumption was tested with the chi-square test for independence of the scaled Schoenfeld residuals and transformed time for each covariate (see Supplementary Information, Table 3 and Fig. 4). A p-value less than 0.05 was considered a statistically significant difference. -Benjamini-Hochberg procedure was used to correct for multiple testing [13]. +Benjamini-Hochberg procedure was used to correct for multiple testing (13). Summary tables, the CONSORT and the forest plots were generated using the packages gtsummary, consort, and survminer, respectively -[14–17]. -All data and analyses are available at https://github.com/umg-minai/crt [18].

+(14–17). +All data and analyses are available at https://github.com/umg-minai/crt (18).

@@ -575,9 +581,9 @@

Analysis of CRT risk factors

Discussion

In this prospective observational study, we found asymptomatic CRT in 70 of 95 CVCs (73.7%) in the IJV of critically ill patients within four weeks after catheterisation. -This incidence of CRT is much higher than previously reported 28 to 56% for IJV CVCs in general surgical ICU or cardiac surgery patients [2,6,19]. +This incidence of CRT is much higher than previously reported 28 to 56% for IJV CVCs in general surgical ICU or cardiac surgery patients (2, 6, 19). To our knowledge, the time of thrombosis onset has not been previously studied in surgical patients. -The median (IQR) time from CVC insertion to CRT diagnosis for all CVCs was 3 (1, 7) days, which is comparable to the previously reported 4 (2, 7) days for CRT onset in critically ill medical patients [4]. +The median (IQR) time from CVC insertion to CRT diagnosis for all CVCs was 3 (1, 7) days, which is comparable to the previously reported 4 (2, 7) days for CRT onset in critically ill medical patients (4). While CRT developed slowly in critically ill medical patients with only 12% of CRTs observed on day one, we found CRT in up to 64.3% of CVCs in critically ill surgical patients within the first 24 hours, depending on the type of CVC. This underscores the importance of clinically reviewing the indication for a CVC critically in the first place, reviewing it on a daily basis, and removing the CVC as early as possible.

Depending on the type of CVC the median time to CRT @@ -585,32 +591,32 @@

Discussion

Causes are difficult to discuss due to differences in manufacturer and material. Previously, different incidences of PE due to CRT have been reported in patients with polyvinyl chloride or polyvinyl catheters compared to those with -polyurethane or siliconized catheters, favouring the latter [8]. +polyurethane or siliconized catheters, favouring the latter (8). We studied two different types of Arrow CVCs, the classic polyurethane and the chlorhexidine acetate and silver sulfadiazine coated polyurethane Arrowg+ard Blue (1st generation) catheters. -Others have reported a lower CRT rate with a chlorhexidine gluconate gel dressing alone [5]. +Others have reported a lower CRT rate with a chlorhexidine gluconate gel dressing alone (5). In contrast we have seen a higher CRT rate with the chlorhexidine acetate coated CVCs. While chlorhexidine should reduce CLABSI it may result in more CRT, which is itself a major risk factor for CLABSI.

Most CRTs are directly associated with vascular endothelial injury. We believe that the most important factors in the development of CRT are the initial endothelial trauma and the hypercoagulability due to perioperative inflammatory stress. Venous stasis due to obstruction, catheter-to-vessel ratio and volume status may play a minor role in the first days but may be more important in the long term. This may explain the higher incidence and earlier onset of CRT compared to medical patients in other studies.

-

The American College of Chest Physicians guideline “Antithrombotic therapy for venous thrombotic embolism (VTE)” defines a large VTE as greater than 7 mm in diameter and greater than 50 mm in length [20]. +

The American College of Chest Physicians guideline “Antithrombotic therapy for venous thrombotic embolism (VTE)” defines a large VTE as greater than 7 mm in diameter and greater than 50 mm in length (20). Only one of the thromboses we found was longer than 50 mm and three (4.3% had a maximum height of more than 7 mm, respectively. Due to the irregular, non-circular shape of the CRT, which is often placed on one side of the CVC, the maximum height does not necessarily correspond to the diameter. -Compared to critically ill medical patients, CRTs were similar in size, with a higher proportion of thicker CRTs (30% over 7 mm) and 0.5% were longer than 50 mm [4].

+Compared to critically ill medical patients, CRTs were similar in size, with a higher proportion of thicker CRTs (30% over 7 mm) and 0.5% were longer than 50 mm (4).

Although CRT size and progression were neither our primary nor secondary outcome, and we did not measure the size every day unless it was obviously different from the previous image, most CRTs were stable in size. -This is in line with the results previously reported [4].

+This is in line with the results previously reported (4).

Despite the high incidence of CRT we didn’t observe any negative outcome. -Thus, our results confirm the guideline recommendation to leave catheters with CRT in place [20,21]. -Removal for thrombosis and reinsertion of a new CVC does not seem necessary and is not recommended [1,20,21]. +Thus, our results confirm the guideline recommendation to leave catheters with CRT in place (20, 21). +Removal for thrombosis and reinsertion of a new CVC does not seem necessary and is not recommended (1, 20, 21). However, the need for therapeutic anticoagulation in asymptomatic incidental should be debated.

The benefit of anticoagulation in CRT is support by our results, as prophylactic anticoagulation at the time of catheter placement appears to be associated with a lower rate of CRT. -Especially in patients with cancer prophylactic anticoagulation could reduce CRT [21,22]. -Interestingly, this was not found in some previous studies [2,4,23]. -However, as mentioned above, except one, all of our and most of the reported CRTs are asymptomatic [2,4,6,21,23]. -That’s why prophylactic or therapeutic anticoagulation should be weighed against the potential harm of major bleeding and other risks of anticoagulation [22].

+Especially in patients with cancer prophylactic anticoagulation could reduce CRT (21, 22). +Interestingly, this was not found in some previous studies (2, 4, 23). +However, as mentioned above, except one, all of our and most of the reported CRTs are asymptomatic (2, 4, 6, 21, 23). +That’s why prophylactic or therapeutic anticoagulation should be weighed against the potential harm of major bleeding and other risks of anticoagulation (22).

Limitations

As this was an exploratory observational study and we were limited by @@ -619,17 +625,17 @@

Limitations

We had to exclude more than half of all CVCs because of poor ultrasound accessibility, lack of LOT information, or small number of catheter types. However, assigning CVCs with missing LOT information to each manufacturer’s main type increases the sample size from 95 to 120, with very similar results (see Supplementary Information, Table 7). Depending on the vessel, the sensitivity and specificity of ultrasound for the diagnosis of DVT are 87 to 94% and 85 to 97%, respectively. -Serial ultrasound, as in our study, increases sensitivity and specificity up 97.9% and 99.8%, respectively [24,25]. +Serial ultrasound, as in our study, increases sensitivity and specificity up 97.9% and 99.8%, respectively (24, 25). Nevertheless, the true accuracy of ultrasonography in the diagnosis of CRT in the IJV is not known.

Although we focused on the IJV, our ultrasound access was limited to the proximal part of the CVC. This may led to an underestimation of the incidence of CRT.

When the patient was discharged from the ICU, we stopped the ultrasound examination, which may also underestimate the incidence of CRT.

-

Cancer is a well-known risk factor for CRT [1,3,7,22]. +

Cancer is a well-known risk factor for CRT (1, 3, 7, 22). However, cancer includes different types of malignancies, but due to our relatively small sample size, we were not able to perform a subgroup analysis by the type of cancer. We did not record the type and duration of the surgery, which may also influence the incidence of CRT.

-

While our data suggest that women had a higher risk of CRT, the numbers of different CVCs in both sex subgroups are too heterogeneous and the subgroups are too small for any meaningful conclusion. A recent meta-analysis found no association between sex and CRT [7].

+

While our data suggest that women had a higher risk of CRT, the numbers of different CVCs in both sex subgroups are too heterogeneous and the subgroups are too small for any meaningful conclusion. A recent meta-analysis found no association between sex and CRT (7).

Due to missing information and its exploratory nature, our study is underpowered to draw conclusions about the effect of multiple insertion attempts and the operator experience. -However, in the reduced sample size we found no difference (see Supplementary Information, Table 5) which is in line with previous studies showing that the number of insertion attempts and operator experience may be unrelated to CRT [19,23].

+However, in the reduced sample size we found no difference (see Supplementary Information, Table 5) which is in line with previous studies showing that the number of insertion attempts and operator experience may be unrelated to CRT (19, 23).

@@ -639,25 +645,41 @@

Conclusions

Possible explanations include vascular trauma and perioperative inflammation. In general, these thromboses are asymptomatic and don’t require treatment. However, the differences in CVC material and the resulting CRTs have been neglected in clinical research and need to be further investigated.

-
-
-

List of abbreviations

-

CLABSI: central line associated bloodstream infection

-

CRP: C-related peptide

-

CRT: catheters-related thrombosis

-

CVC: central venous catheters

-

DOAC: direct oral anticoagulation

-

DVT: deep vein thrombosis

-

FV: femoral vein

-

ICU: intensive care unit

-

IQR: inter-quartile range

-

IJV: internal jugular vein

-

LMWH: low molecular weight heparin

-

PE: pulmonary embolism

-

SCV: subclavian vein

-

UFH: unfractionated heparin

-

VTE: venous thrombotic embolism

-

WBC: white blood cell counts

+

Declarations

@@ -673,7 +695,7 @@

Consent for publication

Availability of data and materials

The datasets generated and/or analysed during the current study are available in the zenodo repository, -https://doi.org/10.5281/zenodo.10396907 [18].

+https://doi.org/10.5281/zenodo.10396907 (18).

Competing interests

@@ -698,98 +720,98 @@

References

-1. Geerts W. Central venous catheterrelated thrombosis. Hematology. 2014;2014:306–11. +
1.
Geerts W: Central venous catheterrelated thrombosis. Hematology 2014; 2014:306–311
-2. Malinoski D, Ewing T, Bhakta A, Schutz R, Imayanagita B, Casas T, et al. Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis. Journal of Trauma and Acute Care Surgery. 2013;74:454–62. +
2.
Malinoski D, Ewing T, Bhakta A, et al.: Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis. Journal of Trauma and Acute Care Surgery 2013; 74:454–462
-3. Haggstrom L, Parmar G, Brungs D. Central venous catheter thrombosis in cancer: A multi-centre retrospective study investigating risk factors and contemporary trends in management. Clinical Medicine Insights: Oncology. 2020;14:117955492095309. +
3.
Haggstrom L, Parmar G, Brungs D: Central venous catheter thrombosis in cancer: A multi-centre retrospective study investigating risk factors and contemporary trends in management. Clinical Medicine Insights: Oncology 2020; 14:117955492095309
-4. Wu C, Zhang M, Gu W, Wang C, Zheng X, Zhang J, et al. Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: A prospective multicenter study. Intens Care Med. 2023;49:401–10. +
4.
Wu C, Zhang M, Gu W, et al.: Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: A prospective multicenter study. Intens Care Med 2023; 49:401–410
-5. Yamashita T, Takamori A, Nakagawachi A, Tanigawa Y, Hamada Y, Aoki Y, et al. Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: A retrospective cohort study. Sci Rep. 2020;10. +
5.
Yamashita T, Takamori A, Nakagawachi A, et al.: Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: A retrospective cohort study. Sci Rep 2020; 10
-6. Wu X, Studer W, Skarvan K, Seeberger MD. High incidence of intravenous thrombi after short-term central venous catheterization of the internal jugular vein. J Clin Anesth. 1999;11:482–5. +
6.
Wu X, Studer W, Skarvan K, et al.: High incidence of intravenous thrombi after short-term central venous catheterization of the internal jugular vein. J Clin Anesth 1999; 11:482–485
-7. Liu GD, Ma WJ, Liu HX, Tang L, Tan YH. Risk factors associated with catheter-related venous thrombosis: A meta-analysis. Public Health. 2022;205:45–54. +
7.
Liu GD, Ma WJ, Liu HX, et al.: Risk factors associated with catheter-related venous thrombosis: A meta-analysis. Public Health 2022; 205:45–54
-8. Monreal M, Raventos A, Lerma R, Ruiz J, Lafoz E, Alastrue A, et al. Pulmonary embolism in patients with upper extremity DVT associated to venous central lines - a prospective study. Thromb Haemostasis. 1994;72:548–50. +
8.
Monreal M, Raventos A, Lerma R, et al.: Pulmonary embolism in patients with upper extremity DVT associated to venous central lines - a prospective study. Thromb Haemostasis 1994; 72:548–550
-9. R Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2023. Available from: https://www.R-project.org/ +
9.
R Core Team: R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2023. Available from: https://www.R-project.org/
-10. Terry M. Therneau, Patricia M. Grambsch. Modeling survival data: Extending the Cox model. New York: Springer; 2000. +
10.
Terry M. Therneau, Patricia M. Grambsch: Modeling survival data: Extending the Cox model. New York: Springer; 2000.
-11. Therneau TM. Survival: Survival analysis [Internet]. 2023. Available from: https://github.com/therneau/survival +
11.
Therneau TM: Survival: Survival analysis [Internet]. 2023. Available from: https://github.com/therneau/survival
-12. Cox DR. Regression models and life-tables. J R Stat Soc Series B. 1972;34:187–202. +
12.
Cox DR: Regression models and life-tables. J R Stat Soc Series B 1972; 34:187–202
-13. Benjamini Y, Hochberg Y. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J R Stat Soc Series B. 1995;57:289–300. +
13.
Benjamini Y, Hochberg Y: Controlling the false discovery rate: A practical and powerful approach to multiple testing. J R Stat Soc Series B 1995; 57:289–300
-14. Sjoberg DD, Whiting K, Curry M, Lavery JA, Larmarange J. Reproducible summary tables with the gtsummary package. The R Journal [Internet]. 2021;13:570–80. Available from: https://doi.org/10.32614/RJ-2021-053 +
14.
Sjoberg DD, Whiting K, Curry M, et al.: Reproducible summary tables with the gtsummary package [Internet]. The R Journal 2021; 13:570–580Available from: https://doi.org/10.32614/RJ-2021-053
-15. Sjoberg DD, Larmarange J, Curry M, Lavery J, Whiting K, Zabor EC. Gtsummary: Presentation-ready data summary and analytic result tables [Internet]. 2023. Available from: https://github.com/ddsjoberg/gtsummary +
15.
Sjoberg DD, Larmarange J, Curry M, et al.: Gtsummary: Presentation-ready data summary and analytic result tables [Internet]. 2023. Available from: https://github.com/ddsjoberg/gtsummary
-16. Dayim A. Consort: Create consort diagram [Internet]. 2023. Available from: https://github.com/adayim/consort/ +
16.
Dayim A: Consort: Create consort diagram [Internet]. 2023. Available from: https://github.com/adayim/consort/
-17. Kassambara A, Kosinski M, Biecek P. Survminer: Drawing survival curves using ggplot2 [Internet]. 2021. Available from: https://rpkgs.datanovia.com/survminer/index.html +
17.
Kassambara A, Kosinski M, Biecek P: Survminer: Drawing survival curves using ggplot2 [Internet]. 2021. Available from: https://rpkgs.datanovia.com/survminer/index.html
-18. Gibb S. CRT data and analyses [Internet]. Zenodo; 2023. Available from: https://doi.org/10.5281/zenodo.10396907 +
18.
Gibb S: CRT data and analyses [Internet]. 2023; Available from: https://doi.org/10.5281/zenodo.10396907
-19. Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, et al. Central vein catheter-related thrombosis in intensive care patients: Incidence, risks factors, and relationship with catheter-related sepsis. Chest. 1998;114:207–13. +
19.
Timsit JF, Farkas JC, Boyer JM, et al.: Central vein catheter-related thrombosis in intensive care patients: Incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998; 114:207–213
-20. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141:e419S–e496S. +
20.
Kearon C, Akl EA, Comerota AJ, et al.: Antithrombotic therapy for VTE disease. Chest 2012; 141:e419S–e496S
-21. Wall C, Moore J, Thachil J. Catheter-related thrombosis: A practical approach. Journal of the Intensive Care Society. 2015;17:160–7. +
21.
Wall C, Moore J, Thachil J: Catheter-related thrombosis: A practical approach. Journal of the Intensive Care Society 2015; 17:160–167
-22. Kahale LA, Tsolakian IG, Hakoum MB, Matar CF, Barba M, Yosuico VE, et al. Anticoagulation for people with cancer and central venous catheters. Cochrane Db Syst Rev. 2018;2019. +
22.
Kahale LA, Tsolakian IG, Hakoum MB, et al.: Anticoagulation for people with cancer and central venous catheters. Cochrane Db Syst Rev 2018; 2019
-23. Leung A, Heal C, Banks J, Abraham B, Capati G, Pretorius C. The incidence of peripheral catheter related thrombosis in surgical patients. Thrombosis. 2016;2016:1–6. +
23.
Leung A, Heal C, Banks J, et al.: The incidence of peripheral catheter related thrombosis in surgical patients. Thrombosis 2016; 2016:1–6
-24. Patel P, Braun C, Patel P, Bhatt M, Begum H, Wiercioch W, et al. Diagnosis of deep vein thrombosis of the upper extremity: A systematic review and meta-analysis of test accuracy. Blood Advances. 2020;4:2516–22. +
24.
Patel P, Braun C, Patel P, et al.: Diagnosis of deep vein thrombosis of the upper extremity: A systematic review and meta-analysis of test accuracy. Blood Advances 2020; 4:2516–2522
-25. Bhatt M, Braun C, Patel P, Patel P, Begum H, Wiercioch W, et al. Diagnosis of deep vein thrombosis of the lower extremity: A systematic review and meta-analysis of test accuracy. Blood Advances. 2020;4:1250–64. +
25.
Bhatt M, Braun C, Patel P, et al.: Diagnosis of deep vein thrombosis of the lower extremity: A systematic review and meta-analysis of test accuracy. Blood Advances 2020; 4:1250–1264

Tables

-
- @@ -1466,20 +1488,20 @@

Tables

-
- @@ -1890,7 +1912,7 @@

Figures

Flowchart

-The flowchart shows the inclusion and exclusion criteria. CVC, central venous catheter; DOAC, direct oral anticoagulants; FV, femoral vein; SCV, subclavian vein. +The flowchart shows the inclusion and exclusion criteria. CVC, central venous catheter; DOAC, direct oral anticoagulants; FV, femoral vein; SCV, subclavian vein.

Figure 1: The flowchart shows the inclusion and exclusion criteria. CVC, central venous catheter; DOAC, direct oral anticoagulants; FV, femoral vein; SCV, subclavian vein.

@@ -1899,7 +1921,7 @@

Flowchart

Survival plots

-Survival plot showing CRT-free time for all analysed central venous catheters. Confidence intervals overlap and have not been drawn for ease of visualization. +Survival plot showing CRT-free time for all analysed central venous catheters. Confidence intervals overlap and have not been drawn for ease of visualization.

Figure 2: Survival plot showing CRT-free time for all analysed central venous catheters. Confidence intervals overlap and have not been drawn for ease of visualization.

@@ -4030,20 +4052,20 @@

Comparison CRT-free time Arrow4 vs Arrow5

Hazard ratios

-
- @@ -4616,20 +4638,20 @@

Hazard ratios

Figure 11: Hazard ratios for all available variables but with reduced sample size. CRP1: C-reactive peptide on day one; D-dimer1: d-dimer on day one; DVT, deep vein thrombosis; LMWH, low-molecular-weight heparins; UFH, unfractionated heparin; WBC1, white blood cell count on day one.

-
- @@ -5124,20 +5146,20 @@

Hazard ratios

-
- @@ -5695,7 +5717,7 @@

R session information

Git commit hash

-
## [1] "Git commit revision: d95f7f587bb75f10ee32809c815b4c9505f4bb75"
+
## [1] "Git commit revision: 4d1bde81523d0cf78c33b782d3ee3d5a9207ff4a"