[Prevention of venous thromboembolic disease in the critical patient: an assessment of clinical practice in the Community of Madrid].
OBJECTIVE
To analyze measures referred to venous thromboembolic prophylaxis in critically ill patients.


METHODS
An epidemiological, cross-sectional (prevalence cut), multicenter study was performed using an electronic survey. Comparison of results with quality indexes of the Spanish Society of Intensive Care Medicine, the American College of Chest Physician guidelines and international studies.


METHODS
Intensive Care Units (ICUs) in the Community of Madrid (Spain).


METHODS
All patients admitted to the ICU on the day of the survey.


METHODS
General aspects of venous thromboembolic prophylaxis and protocols used (risk stratification and ultrasound screening). A descriptive analysis was performed, continuous data being expressed as the mean or median, and categorical data as percentages.


RESULTS
A total of 234 patients in 18 ICUs were included. Eighteen percent (42/234) received no prophylaxis, and 55% had no contraindication to pharmacological prophylaxis. Of the 192 patients receiving prophylaxis, 84% received pharmacological prophylaxis, 14% mechanical prophylaxis and 2% combined prophylaxis. Low molecular weight heparin was the only pharmacological prophylaxis used, with a majority use of enoxaparin (17 of 18 ICUs). In patients with mechanical prophylaxis (31/192), antiembolic stockings were the most commonly used option (58%). Pharmacological prophylaxis contraindications were reported in 20% of the patients (46/234), the most frequent cause being thrombocytopenia (28% of the cases). Fifty percent of the ICUs used no specific venous thromboembolic prophylaxis protocol.


CONCLUSIONS
Pharmacological prophylaxis with low molecular weight heparin was the most frequently used venous thromboembolic prophylactic measure. In patients with contraindications to pharmacological prophylaxis, mechanical measures were little used. The use of combined prophylaxis was anecdotal. Many of our ICUs lack specific prophylaxis protocols.
Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: garciaolivaresp@gmail.com.
P
P
García-Olivares
Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, España.
J E
JE
Guerrero
Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, España.
M J
MJ
Tomey
Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, España.
A M
AM
Hernangómez
Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, España.
D O
DO
Stanescu
D016638:Critical Illness; D003430:Cross-Sectional Studies; D006801:Humans; D007362:Intensive Care Units; D010818:Practice Patterns, Physicians'; D013030:Spain; D054556:Venous Thromboembolism / Q000517:prevention & control*
Critical patient; Deep venous thrombosys; Enfermedad tromboembólica venosa; Intensive care unit; Paciente crítico; Thromboprophylaxis; Tromboprofilaxis; Trombosis venosa profunda; Unidad de cuidados Intensivos; Venous thromboembolic disease