title: Omission of early thromboprophylaxis and mortality in critically ill patients: a multicenter registry study.
abstract: BACKGROUND
  VTE is a preventable cause of death within hospitals. This study aimed to assess the association between omission of early thromboprophylaxis for > 24 h after ICU admission and mortality in critically ill patients.
  
  
  METHODS
  This study involved 175,665 critically ill adult patients admitted to 134 ICUs in Australia and New Zealand between 2006 and 2010.
  
  
  RESULTS
  The crude ICU and hospital mortality in patients who did not receive thromboprophylaxis within 24 h of ICU admission was higher than those who were treated with early thromboprophylaxis (7.6% vs 6.3%, P = .001; 11.2% vs 10.6%, P = .003, respectively), despite the former patients being associated with a slightly lower acuity of illness (mean APACHE [Acute Physiology and Chronic Health Evaluation] III model predicted mortality, 13% vs 14%; P = .001). The association between omission of early thromboprophylaxis and hospital mortality remained significant after adjusting for other covariates (OR, 1.22; 95% CI, 1.15-1.30; P = .001), particularly for patients with multiple trauma, sepsis, cardiac arrest, and preexisting metastatic cancer. The estimated attributable mortality effect of omitting early thromboprophylaxis for patients with multiple trauma, sepsis, cardiac arrest, and preexisting metastatic cancer was 3.9% (95% CI, 2.2-5.6), 8.0% (95% CI, 5.6-10.4), 15.4% (95% CI, 11.1-19.8), and 9.4% (95% CI, 6.4-12.4), respectively.
  
  
  CONCLUSIONS
  Omission of thromboprophylaxis within the first 24 h of ICU admission without obvious reasons was associated with an increased risk of mortality in critically ill adult patients.
authors.affiliation: Department of Intensive Care Medicine and School of Population Health, Royal Perth Hospital, University of Western Australia, Wellington St, Perth, WA, 6000, Australia. kwok.ho@health.wa.gov.au
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
authors.forename: Shaila
authors.initials: S
authors.lastname: Chavan
authors.forename: David
authors.initials: D
authors.lastname: Pilcher
mesh_terms: D000368:Aged; D001315:Australia; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*; D028761:Withholding Treatment