title: Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis.
abstract: Critically ill patients who develop sepsis may be at a higher risk of venous thromboembolism (VTE) prophylaxis failure; however, studies in this population are limited. The objective of this study was to identify the incidence of VTE prophylaxis failure in this population.
  
  
  
  This retrospective review of patients admitted to the intensive care unit between February 2013 and September 2015 included patients who were diagnosed with sepsis and received heparin or enoxaparin VTE prophylaxis.
  
  
  
  Of the 355 patients included, 42 (12.5%) developed a VTE. Acute respiratory distress syndrome (ARDS) (31% vs 16.7%, P = .0272) and higher positive end expiratory pressure (10 vs 8, P = .0066) were associated with increased risk of VTE prophylaxis failure. Logistic regression identified ARDS an event risk factor (odds ratio, 2.58; 95% confidence interval, 1.22-5.42). The VTE was associated with an increased intensive care unit (14 vs 9 days, P = .01) and hospital length of stay (26 vs 15 days, P < .0001). The median time from sepsis diagnosis to VTE event was 9 days (interquartile range, 5-13).
  
  
  
  Critically ill patients with sepsis had a high rate of VTE prophylaxis failure with ARDS being identified as a risk factor for VTE prophylaxis failure.
authors.affiliation: UF Health Jacksonville, 655 W. 8th Street, Jacksonville, FL 32209. Electronic address: Jennifer.Hanify@jax.ufl.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hanify
authors.affiliation: UF College of Pharmacy Jacksonville Campus, 580 W. 8th Street, Jacksonville, FL 32209. Electronic address: Lori.Dupree@jax.ufl.edu.
authors.forename: Lori H
authors.initials: LH
authors.lastname: Dupree
authors.affiliation: UF Health Jacksonville, 655 W. 8th Street, Jacksonville, FL 32209. Electronic address: Donald.Johnson@jax.ufl.edu.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: UF Health Jacksonville, 655 W. 8th Street, Jacksonville, FL 32209. Electronic address: Jason.Ferreira@jax.ufl.edu.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016638:Critical Illness; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000628:therapy*; D017211:Treatment Failure; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin
keywords: Acute respiratory distress syndrome; Anticoagulant; Critically ill; Sepsis; Thromboprophylaxis; Venous thromboembolism