Venous Thromboembolism in Critically Ill Medical Patients Receiving Chemoprophylaxis: A Focus on Obesity and Other Risk Factors.
OBJECTIVE
To compare the incidence of 90-day venous thromboembolism (VTE) in obese critically ill medical patients receiving VTE chemoprophylaxis with nonobese patients of similar illness severity. We also identified other VTE risk factors.


METHODS
Eligible patients spent ≥24 hours in an intensive care unit between November 2007 and November 2013 and received VTE chemoprophylaxis within 48 hours of admission. The primary outcome was 90-day VTE.


RESULTS
A total of 11 111 patients were evaluated, of which 1732 obese and 1831 nonobese patients were enrolled with mean BMIs of 38.9 ± 9.2 kg/m(2) and 24.5 ± 3.1 kg/m(2) and mean Acute Physiology and Chronic Health Evaluation II scores of 28.4 ± 11.8 and 26.6 ± 11.7, respectively. The rate of 90-day VTE for the total cohort, obese, and nonobese patients was 6.5%, 7.5%, and 5.5%, respectively. Obese patients were more likely to develop VTE compared with nonobese patients (odds ratio [OR]: 1.41; 95% confidence interval [CI]: 1.03 -1.93). Other risk factors significantly associated with 90-day VTE included prior VTE (OR: 3.93; 95% CI: 1.83-8.48), trauma with surgery in the previous 30 days (OR: 3.70; 95% CI: 1.39-9.86), central venous catheters (OR: 2.64; 95% CI: 1.87-3.72), surgery within 90 days (OR: 2.40; 95% CI: 1.61-3.58), mechanical ventilation (OR: 1.94; 95% CI: 1.39-2.71), male sex (OR: 1.55; 95% CI: 1.13-2.14), and increasing age using 1-year increments (OR: 1.02; 95% CI: 1.01 -1.03).


CONCLUSIONS
The rate of VTE in critically ill medical patients remains high despite standard chemoprophylaxis. Obesity is among 8 risk factors independently associated with 90-day VTE.
Department of Pharmacy, Critical Care Medicine Division, Intermountain Medical Center, Murray, UT, USA fontaine.gabe@gmail.com gabriel.fontaine@imail.org.
Gabriel V
GV
Fontaine
Department of Pharmacy, Critical Care Medicine Division, Intermountain Medical Center, Murray, UT, USA.
Emily
E
Vigil
Department of Pharmacy, Critical Care Medicine Division, Intermountain Medical Center, Murray, UT, USA.
Paul D
PD
Wohlt
Department of Medical Informatics, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT, USA.
James F
JF
Lloyd
Department of Biomedical Informatics, Intermountain Healthcare, University of Utah, Salt Lake City, UT, USA Department of Medical Informatics, LDS Hospital, Salt Lake City, UT, USA.
R Scott
RS
Evans
Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA.
David S
DS
Collingridge
Department of Medicine, Intermountain Medical Center, Murray, UT, USA Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Scott M
SM
Stevens
Department of Medicine, Intermountain Medical Center, Murray, UT, USA Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Scott C
SC
Woller
D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery
deep vein thrombosis; pulmonary embolism; thrombosis; thrombosis prophylaxis; venous thromboembolism