[Anticoagulation in critically ill patient].
Incidence of deep vein thrombosis in critically ill patients depends on the underlying disease but may be as high as 60%. In patients with severe sepsis or septic shock, Surviving Sepsis Campaign clearly recommends administering anticoagulation in the absence of specific contraindications. The article discusses risk factor for thromboembolic events in critical illness, non-pharmacological and pharmacological thrombosis prophylaxis as well as means of monitoring anticoagulation. Considering the ideal route of administration in intensive care patients, peripheral vasoconstriction, edema, shock, and administration of catecholamines may reduce bioavailability and efficacy of subcutaneous administration of low molecular weight heparin (LMWH). Dosing of the direct thrombin inhibitor argatroban depends on the severity of illness (SAPS II-score) and is up to 10-times lower than in patients without critical illness.
Fries
Dietmar
D
Klinische Abteilung für Allgemeine und Chirurgische Intensivmedizin, Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria. dietmar.fries@i-med.ac.at
D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D001682:Biological Availability; D001780:Blood Coagulation Tests; D000075202:Contraindications; D003422:Critical Care / Q000379:methods*; D016903:Drug Monitoring; D006493:Heparin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D010875:Pipecolic Acids / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000628:therapy*; D013449:Sulfonamides; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban