Prevention of venous thromboembolism in critically ill surgery patients: a cross-sectional study.
BACKGROUND
The risk for venous thromboembolism (VTE) and the risk for bleeding among critically ill surgical patients are both important in the early postoperative period.


METHODS
To record VTE prophylaxis prescribed for surgical patients in the intensive care unit (ICU) within the first postoperative week. We conducted a prospective observational cross-sectional study of Canadian university affiliated ICUs.


RESULTS
Of 29 ICU Directors approached, 28 (96.6%) participated, representing 34 ICUs and 589 ICU beds across Canada. Among 89 patients, surgical procedures were 32 abdominal (36.0%), 19 vascular (21.3%), 10 orthopedic (11.2%), 9 trauma (10.1%), 8 neurologic (9.0%), 5 thoracic (5.6%), 5 gynecologic (5.6%), and 1 for necrotizing fasciitis (1.1%). VTE prophylaxis with unfractionated heparin, low molecular weight heparin, and intermittent pneumatic compression was used in 35 of 89 (39.3%), 8 of 89 (9.0%), and 9 of 89 (10.1%) patients, respectively, whereas 8 of 89 (9.0%) patients were receiving therapeutic anticoagulation. Two methods of VTE prophylaxis were prescribed for 20 of 89 (22.5%) patients. Prophylaxis with unfractionated or low molecular weight heparin was significantly less likely to be prescribed for postoperative ICU patients requiring mechanical ventilation compared with those weaned from mechanical ventilation (odds ratio [OR] 0.36, P =.03). The use of intermittent pneumatic compression devices was significantly associated with current hemorrhage (OR 13.5, P =.02), and risk for future hemorrhage (OR 19.3, P =.001).


CONCLUSIONS
VTE prevention for surgical ICU patients within the first postoperative week appear to be individualized, and influenced by current and future risks of thrombosis and bleeding.
Cook
D
D
Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Laporta
D
D
Skrobik
Y
Y
Peters
S
S
Sharpe
M
M
Murphy
P
P
Chin
D
D
Crowther
M
M
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001458:Bandages / Q000706:statistics & numerical data; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication / Q000706:statistics & numerical data*; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight