Background Venous thromboembolism (VTE) is a common and potentially lethal complication from hospitalisation. Critically ill patients have multiple risk factors for VTE such as prolonged immobility, use of central venous catheters, mechanical ventilation complications related to comorbidities. To reduce the incidence of VTE, various pharmacologic and mechanical thromboprophylaxis (TP) regimes are available.
Purpose To characterise the prophylactic strategies used in a cohort of critically ill patients during their stay in ICU length and their adherence to hospital guidelines for the prevention of VTE.
Materials and methods We conducted a prospective review of all patients admitted to a traumatic and neurocritical ICU from July 2013 to September of 2013. Patients were excluded if they were being treated for VTE diagnosed before, or were therapeutically anticoagulated for other reasons prior to ICU admission. For ICU patients our guidelines recommend anticoagulant TP with low-molecular-weight heparin (LMWH) as soon as it is safe, if it is not contraindicated. However, it is more common in ICU to start TP using mechanical methods because of the high risk of bleeding for the first few days, in which LMWH are contraindicated.
A high risk of bleeding was defined as symptomatic bleeding, presence of organic lesions likely to bleed, haemophiliac diseases, haemostatic abnormalities (platelet count <50000/mm3; aPTT ratio >2; prothrombin time (IQ) <40%), or severe anaemia (haemoglobin <7 g/dL) due to bleeding or unknown causes.
We collected bio-demographic data and other clinical data related to VTE.
Results Over the study period 34 patients were admitted to the ICU. Of these, 4 were excluded. We therefore enrolled 30 patients, with a mean age of 45.5 years; of which 86.6% were men. The median length of stay in the ICU was 17 days (3–51).
The main diagnostics for ICU admission were: acute spinal cord injury (SCI) (30%), stroke (26.6%) and head injury (23.3%).
Of all the patients enrolled, 26 (87.7%) received TP treatment.
Of the patients who used mechanical TP (43.75%), 96.6% used intermittent pneumatic compression (IPC) and 3.3% used graduated compression stockings (GCS). The mean time to start treatment (MTS) was 1.7 days, and the mean treatment period (MTP) was 12.3 days.
Of the patients treated with LMWH (always according to renal function) (84.3%):
50% received both, first mechanical and then pharmacologic TP, with a MTS of 13.7 days and a MTP of 11.9 days.
50% received LMWH as a first line treatment, with a MTS of 5.4 days and a MTP of 8.7 days.
The main diagnostics for unsafe LMWH treatment and prolonged mechanical measures were: head injury (30.8%) and stroke (38.5%).
Of all the patients, only 4 (13.3%) did not receive any TP treatment during their stay in ICU.
During the study period, any occurrences of VTE were recorded but we do not know if any events occurred after the patients were discharged.
Conclusions Overall, patients in this study received a high level of VTE prophylaxis (87.7%)
Our ICU adheres appropriately to the hospital’s guidelines for the prevention of VTE. A high percentage of the patients initially received mechanical TP on the first or second day, and started late treatment with LMWH because of the high risk of bleeding.
However we believe that there was a small number of patients who should have started the TP treatment earlier, and we should evaluate the cause in order to influence policy and propose strategies for improvement.
Including a pharmacist in the multidisciplinary team of critical care practitioners in the ICU is necessary to optimise treatments.
No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.