Bleeding and venous thromboembolism in the critically ill with emphasis on patients with renal insufficiency.
OBJECTIVE
The purpose of this review is to critique and summarize clinical literature relevant to thromboprophylaxis in critically ill patients with renal insufficiency. The specific objectives are to discuss factors that increase the risks for bleeding and venous thromboembolism in critically ill patients, with a focus on patients with renal insufficiency, and to consider prophylaxis management options and the rationale for their use.


RESULTS
Herein, we discuss both bleeding and venous thromboembolism in this population, both of which are of concern as complications. Bleeding is common among critically ill patients and has important clinical consequences. Critically ill patients with renal insufficiency require special consideration in regard to thromboprophylaxis. Such patients have a four-fold higher risk for developing venous thromboembolism compared with ICU patients without renal insufficiency. ICU patients have dynamic risks of thrombosis and bleeding. Invasive procedures may require temporary interruption of anticoagulants. Consequently, approaches to thromboprophylaxis require daily reevaluation.


CONCLUSIONS
We provide some considerations for practice in the conclusion section.
Cook
Deborah J
DJ
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca
Douketis
James
J
Arnold
Donald
D
Crowther
Mark A
MA
D016638:Critical Illness; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
D005343:Fibrinolytic Agents; D006490:Hemostatics