Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis.
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France. CMinet@chu-grenoble.fr.
Clémence
C
Minet
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Leila
L
Potton
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Agnès
A
Bonadona
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Rébecca
R
Hamidfar-Roy
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Claire Ara
CA
Somohano
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Maxime
M
Lugosi
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Jean-Charles
JC
Cartier
Department of Radiology, UJF-Grenoble I, University Hospital Albert Michallon, Grenoble, F-38041, France.|UJF-Grenoble I, University Hospital Albert Michallon, U823 Institut Albert Bonniot, Team 11: Outcome of mechanically ventilated patients and airway cancers, Grenoble, F-38041, France.
Gilbert
G
Ferretti
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.
Carole
C
Schwebel
UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France.|UJF-Grenoble I, University Hospital Albert Michallon, U823 Institut Albert Bonniot, Team 11: Outcome of mechanically ventilated patients and airway cancers, Grenoble, F-38041, France.
Jean-François
JF
Timsit
D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000517:prevention & control; D012307:Risk Factors; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000517:prevention & control
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight