HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Geerts, W. Articles by Selby, R. Search for Related Content PubMed PubMed Citation Articles by Geerts, W. Articles by Selby, R.

Prevention of Venous Thromboembolism in the ICU^*

^* From the Department of Medicine, University of Toronto, Toronto, ON, Canada.

Correspondence to: William Geerts, MD, FCCP, Thromboembolism Program, Sunnybrook & Women’s College Health Sciences Centre, Room D674, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5

Background: Although venous thromboembolism (VTE) is an important cause of morbidity and mortality in critical care unit patients, the risk of VTE and its prevention have been poorly characterized in this population. Evidence-based thromboprophylaxis guidelines are also not available for these critically ill patients.

Objectives: To review the prevalence of VTE, to summarize the available clinical trials of thromboprophylaxis, and to outline a practical approach to the prevention of VTE in critical care unit patients.

Methods: Systematic review of the relevant literature.

Results: Most patients in critical care units have at least one major risk factor for VTE, and many patients have multiple risk factors. Objectively confirmed deep-vein thrombosis (DVT) rates varied from 13 to 31% among the four prospective studies in which critical care unit patients did not receive prophylaxis. We were able to identify only three randomized trials of thromboprophylaxis conducted in critical care units. The results of these studies suggest that both low-dose heparin and low-molecular-weight heparin are efficacious in preventing DVT compared with no prophylaxis. Fourteen studies reported that compliance with some form of thromboprophylaxis occurred in 33 to 100% of critically ill patients.

Conclusions: There is a paucity of data assessing the risks and prevention of VTE in critical care settings. Selection of prophylaxis for these challenging patients involves a consideration of the thromboembolic and bleeding risks, both of which may vary in the same patient from day to day.

Key Words: compliance • critical care • ICU • patient safety • thromboprophylaxis • venous thrombosis

This article has been cited by other articles:

				A. Limpus, W. Chaboyer, E. McDonald, and L. Thalib Mechanical thromboprophylaxis in critically ill patients: a systematic review and meta-analysis. Am. J. Crit. Care., July 1, 2006; 15(4): 402 - 412. [Abstract] [Full Text] [PDF]

				E. S. Darze, A. L. Latado, A. G. Guimaraes, R. A. V. Guedes, A. B. Santos, S. S. de Moura, and L. C. S. Passos Incidence and Clinical Predictors of Pulmonary Embolism in Severe Heart Failure Patients Admitted to a Coronary Care Unit Chest, October 1, 2005; 128(4): 2576 - 2580. [Abstract] [Full Text] [PDF]

				K. Lacut, L. Bressollette, G. Le Gal, E. Etienne, A. De Tinteniac, A. Renault, F. Rouhart, G. Besson, J. -F. Garcia, D. Mottier, et al. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage Neurology, September 27, 2005; 65(6): 865 - 869. [Abstract] [Full Text] [PDF]

				L. G. Futterman and L. Lemberg A Silent Killer--Often Preventable Am. J. Crit. Care., September 1, 2004; 13(5): 431 - 436. [Full Text] [PDF]