title: Efficacy of deep venous thrombosis prophylaxis in the medical intensive care unit.
abstract: The purpose of this study was to determine the incidence of deep venous thrombosis in medical intensive care unit patients receiving deep venous thrombosis prophylaxis. This was a prospective cohort study of 141 consecutive adult patients anticipated to remain in the medical intensive care unit for >48 hours. Deep venous thrombosis prophylaxis was provided using subcutaneous unfractionated heparin or a sequential compression device according to risk-stratified protocol. Compression ultrasound was performed. Fourteen patients (9.9%) developed deep venous thrombosis on follow-up studies. Incidence of deep venous thrombosis was 7.9% per person year (95% confidence interval, 4.8-12.8). Two of 14 developed pulmonary embolism. Eight patients required full anticoagulation with intravenous heparin or coumadin. In-hospital mortality was similar in both groups. Patients with deep venous thrombosis had a statistically higher risk of pulmonary embolism: 14.2% (95% confidence interval, 2.0-43.0) versus 0.0% (95% confidence interval, 0-3; P = .009). Incidence of deep venous thrombosis is high in medical intensive care unit patients receiving standard prophylaxis. Adherence to strict deep venous thrombosis prophylaxis protocol and exploration of other prophylaxis regimens should be pursued.
authors.affiliation: St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA. hkhouli@chpnet.org
authors.forename: Hassan
authors.initials: H
authors.lastname: Khouli
authors.forename: Janet
authors.initials: J
authors.lastname: Shapiro
authors.forename: Vinh Philip
authors.initials: VP
authors.lastname: Pham
authors.forename: Asghar
authors.initials: A
authors.lastname: Arfaei
authors.forename: Olanrewaju
authors.initials: O
authors.lastname: Esan
authors.forename: Raymonde
authors.initials: R
authors.lastname: Jean
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007279:Injections, Subcutaneous; D007362:Intensive Care Units; D048228:Intermittent Pneumatic Compression Devices; D007902:Length of Stay; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin