title: Thrombosis prophylaxis in critically ill patients.
abstract: Incidence of deep vein thrombosis in critically ill patients depends on the underlying disease but may be as high as 60%. The Surviving Sepsis Campaign clearly recommends administering anticoagulation in the absence of specific contraindications in patients with severe sepsis or septic shock. The article discusses risk factor for thromboembolic events in critical illness as well as means of non-pharmacologic and pharmacologic thrombosis prophylaxis. Peripheral vasoconstriction, edema, shock, and administration of catecholamines may reduce the bioavailability and efficacy of subcutaneous administration of low molecular weight heparin. This article further elaborates on the problem and pathophysiology of heparin resistance. Continuous intravenous administration of new anticoagulants may be a promising alternative to indirect anticoagulants. Severity of illness and SAPS II-score determine dosing of the direct thrombin inhibitor argatroban which needs to be about 10-times lower than in patients without critical illness.
authors.affiliation: Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria. dietmar.fries@i-med.ac.at
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D001682:Biological Availability; D019457:Chromosome Breakage; D025063:Chromosome Disorders / Q000097:blood / Q000188:drug therapy; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D006493:Heparin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D010875:Pipecolic Acids / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012307:Risk Factors; D018805:Sepsis / Q000097:blood* / Q000188:drug therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000188:drug therapy*; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000097:blood / Q000151:congenital / Q000188:drug therapy; D020246:Venous Thrombosis / Q000097:blood / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006629:Hirudins; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban; C083544:lepirudin