title: Clinical factors associated with inappropriate prophylaxis of venous thromboembolic disease in critically ill patients. A single day cross-sectional study.
abstract: OBJECTIVE
  A poor implementation of VTE prophylactic measures recommended for critically ill patients has been observed in several epidemiological studies. The clinical factors associated with this have not been clearly established. The objective of our study was to identify which factors could be related to the inappropriate use of VTE prophylaxis.
  
  
  METHODS
  Analytic epidemiological study based on different aspects of VTE prophylaxis performed on Spanish ICU patients. A multiple logistic regression analysis was conducted to identify the risk factors associated with inappropriate prophylaxis, according to the American College of Chest Physicians 2012 guidelines.
  
  
  RESULTS
  We enrolled 777 patients. On admission, 62% presented medical, 30% surgical and 8% major trauma pathology. Of all patients, 41% were receiving an inappropriate prophylaxis, including 19% which did not receive any prophylaxis. The presence of a contraindication for pharmacological prophylaxis (OR 3.91, 95% CI 2.50-6.10) and non-medical pathology at ICU admission (OR 11.09; 95% CI 7.63-16.12) were associated with inappropriate prophylaxis. In contrast, mechanical ventilation (OR 0.70, 95% CI 0.45-0.98), bed rest>48h (OR 0.61, 95% CI 0.49-0.98), the use of a protocol for VTE prophylaxis (OR 0.66, 95% CI 0.45-0.98) and a VTE risk scoring system (OR 0.49, 95% CI 0.24-0.98) were associated with adequate prophylaxis.
  
  
  CONCLUSIONS
  Our study highlighted a poor compliance with the VTE prophylaxis recommendations proposed for critical patients. The implementation of specific protocols for prophylaxis that include a correct evaluation according to VTE and haemorrhage risk, would allow for optimisation of mechanical and combined prophylaxis, improving adherence to the clinical practice guidelines.
authors.affiliation: Intensive Care Unit, Gregorio Marañón Universitary Hospital, Madrid, Spain. Electronic address: garciaolivaresp@gmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: García-Olivares
authors.affiliation: Intensive Care Unit, Gregorio Marañón Universitary Hospital, Madrid, Spain.
authors.forename: Jose Eugenio
authors.initials: JE
authors.lastname: Guerrero
authors.affiliation: Intensive Care Unit, Gregorio Marañón Universitary Hospital, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Keough
authors.affiliation: Intensive Care Unit, Puerta de Hierro Universitary Hospital, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Galdos
authors.affiliation: Intensive Care Unit, León Universitary Hospital, León, Spain.
authors.forename: Demetrio
authors.initials: D
authors.lastname: Carriedo
authors.affiliation: Intensive Care Unit, Virgen del Rocio Universitary Hospital, Sevilla, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Murillo
authors.affiliation: Intensive Care Unit, San Agustin Hospital, Asturias, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotic therapy; Critical care unit; Critically ill patients; Cross-sectional study; Venous thromboembolic disease