Venous Thromboembolism (VTE) Prophylaxis in the Intensive Care Unit (ICU)

2017 ◽  
pp. 127-133
Author(s):  
Dillon Elliott
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Vte Prophylaxis

scholarly journals Does Obesity Predispose Medical Intensive Care Unit Patients to Venous Thromboembolism despite Prophylaxis? A Retrospective Chart Review

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Bradley J. Peters ◽  
Ross A. Dierkhising ◽  
Kristin C. Mara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Risk Model ◽  
Medical Intensive Care Unit ◽  
Statistical Significance ◽  
The Body ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Medical Intensive Care

Background. Obesity is a significant issue in the critically ill population. There is little evidence directing the dosing of venous thromboembolism (VTE) prophylaxis within this population. We aimed to determine whether obesity predisposes medical intensive care unit patients to venous thromboembolism despite standard chemoprophylaxis with 5000 international units of subcutaneous heparin three times daily. Results. We found a 60% increased risk of venous thromboembolism in the body mass index (BMI) ≥ 30 kg/m2 group compared to the BMI < 30 kg/m2 group; however, this difference did not reach statistical significance. After further utilizing our risk model, neither obesity nor mechanical ventilation reached statistical significance; however, vasopressor administration was associated with a threefold risk. Conclusions. We can conclude that obesity did increase the rate of VTE, but not to a statistically significant level in this single center medical intensive care unit population.

628 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S169-S170
Author(s):  
Sarah A Folliard ◽  
Jared L Gabbert ◽  
Kelli Rumbaugh ◽  
Callie M Thompson ◽  
Cathy Oleis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Thromboembolism Prophylaxis ◽  
Surgical Interventions ◽  
Vte Prophylaxis ◽  
Improve Compliance

Abstract Introduction Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population. Methods A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events. Results Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE. Conclusions Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff.

Implementation of an Enoxaparin Protocol for Venous Thromboembolism Prophylaxis in Obese Surgical Intensive Care Unit Patients

2011 ◽  
Vol 45 (11) ◽  
pp. 1356-1362 ◽  
Author(s):  
Kyle P Ludwig ◽  
Heidi J Simons ◽  
Mary Mone ◽  
Richard G Barton ◽  
Edward J Kimball
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Factor Xa ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Surgical Intensive Care ◽  
Vte Prophylaxis

Background:: Venous thromboembolism (VTE) is a serious health care issue that affects a large number of people. Few standards exist for delineating the optimal dosing strategy for VTE prevention in obese patients, especially in the setting of major surgery or trauma. Objective: To document the efficacy of a surgical intensive care unit (SICU)–specific, weight-based dosing protocol of enoxaparin 0.5 mg/kg given subcutaneously every 12 hours for VTE prophylaxis in morbidly obese (defined as body mass index [BMI] ≥35 kg/m2 or weight ≥150 kg) SICU patients, using peak anti-factor Xa levels to determine therapeutic endpoints. Methods: Data were collected retrospectively in an academic, university-based SICU on 23 morbidly obese patients who received weight-based enoxaparin for VTE prophylaxis from December 1, 2008, through June 30, 2010. Results: A weight-based dosage range of enoxaparin 50-120 mg twice daily (median 60) was given to 23 patients. The mean BMI was 46.4 kg/m2. The initial mean anti-factor Xa level (measured after the third dose) was 0.34 IU/mL (range 0.20-0.59). Patients received an average of 18 doses. Two cases required an increase or decrease in dosage based on anti-factor Xa levels. Morbidity related to this dosing included a single event of minor endotracheal bleeding and a single deep vein thrombosis that was likely present prior to treatment. Conclusions: Weight-based dosing with enoxaparin in morbidly obese SICU patients was effective in achieving anti-factor Xa levels within the appropriate prophylactic range. This regimen reduced the rate of VTE below expected levels and no additional adverse effects were reported.

scholarly journals Venous Thromboembolism Prophylaxis in Medical Intensive Care Unit: An Audit

2021 ◽  
Author(s):  
Basant Kumar Pathak ◽  
P Harikrishnan ◽  
Manish Manrai
Keyword(s):  
Risk Assessment ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Medical Records ◽  
Assessment Model ◽  
P Value ◽  
Vte Prophylaxis ◽  
Significant Difference

Introduction: Venous Thromboembolism (VTE) is a major cause of morbidity and mortality in patients admitted to healthcare facilities. This can be prevented by giving thromboprophylaxis to patients after assessing the risk for VTE. This however is not being routinely done leading to underuse of thromboprophylaxis due to inadequate practice of risk assessment. Aim: To conduct an audit of VTE prophylaxis in Intensive Care Unit (ICU) based on Padua score and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Risk Assessment Model (VTE RAM). Materials and Methods: This was a cross-sectional observational study and the data was collected from medical records of patients retrospectively who were admitted to medical ICU between October 2019 and December 2019. Based on medical records risk assessment was done using the Padua score and IMPROVE VTE RAM. The prophylaxis given to patients was scrutinised for appropriateness based on American Society of Haematology (ASH) guidelines. The two validated scores Padua score and IMPROVE VTE RAM were compared with each other for any significant difference in the risk assessment made using Chi-square test and p-value <0.05 were considered significant. Results: Out of the 176 patients risk assessment was not done in any patient. On calculating the Padua score, 149 patients (84.66%) were in high risk for VTE (Padua Score ≥4) and amongst them only 76 (51%) patients received thromboprophylaxis. On calculating the IMPROVE VTE RAM score, 137 patients (77.84%) were in moderate or high risk for VTE requiring prophylaxis and amongst them only 76 (55.47%) patients received thromboprophylaxis. The accuracy of clinician’s judgement without risk assessment was 58.52% (95% CI: 65.80%-51.24%) and 64.20% (95% CI: 71.28%-57.12%) as compared to risk assessment by Padua score and IMPROVE VTE RAM, respectively. There was no significant difference between IMPROVE VTE RAM and Padua score with respect to risk assessment for VTE (p-value of 0.10). Conclusion: The practice of VTE prophylaxis is grossly inadequate and there is a requirement to sensitise the healthcare providers about the importance of risk assessment for VTE.

scholarly journals Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

2021 ◽  
Vol 6 (1) ◽  
pp. e000643
Author(s):  
Joseph F Rappold ◽  
Forest R Sheppard ◽  
Samuel P Carmichael II ◽  
Joseph Cuschieri ◽  
Eric Ley ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Patient Care ◽  
American Association ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Clinical Patient ◽  
Consensus Document

Venous thromboembolism (VTE) is a potential sequela of injury, surgery, and critical illness. Patients in the Trauma Intensive Care Unit are at risk for this condition, prompting daily discussions during patient care rounds and routine use of mechanical and/or pharmacologic prophylaxis measures. While VTE rightfully garners much attention in clinical patient care and in the medical literature, optimal strategies for VTE prevention are still evolving. Furthermore, trauma and surgical patients often have real or perceived contraindications to prophylaxis that affect the timing of preventive measures and the consistency with which they can be applied. In this Clinical Consensus Document, the American Association for the Surgery of Trauma Critical Care Committee addresses several practical clinical questions pertaining to specific or unique aspects of VTE prophylaxis in critically ill and injured patients.

790 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S230-S231
Author(s):  
Sarah A Folliard ◽  
Jared L Gabbert ◽  
Callie M Thompson
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Body Mass ◽  
Total Body Surface Area ◽  
Successful Implementation ◽  
Burn Patients ◽  
Vte Prophylaxis

Abstract Introduction Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). Patients with impaired renal function or a contraindication to enoxaparin were given LDUH 5,000 units every 8 hours. The purpose of this study was to examine compliance with the new protocol and overall rates of VTE. Methods A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events. Results Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE. Conclusions Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff. Applicability of Research to Practice Although protocols can improve consistency of health care, reduce costs and improve health outcomes, they must be properly utilized in order to see the benefits. Successful implementation of protocols requires a multistep approach that includes a strong quality improvement process, multidisciplinary buy-in, ongoing education efforts, and assessment to review adherence to and efficacy of the protocols themselves.

scholarly journals Ketepatan dan Kecukupan Profilaksis Venous Thromboembolism berdasar Pedoman American College of Chest Physicians di Ruang Rawat Intensif Rumah Sakit DR. Hasan Sadikin Bandung Periode Januari–Desember 2016

2019 ◽  
Vol 7 (2) ◽  
pp. 100-108
Author(s):  
Tirto Hartono ◽  
Ezra Oktaliansah ◽  
Ardi Zulfariansyah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
General Hospital ◽  
Compliance Rate ◽  
Special Treatment ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Critical Patients ◽  
Almost All

Pasien sakit kritis adalah pasien dengan kondisi mengancam nyawa yang membutuhkan penanganan khusus di ruang rawat intensif (intensive care unit; ICU). Hampir semua pasien kritis yang dirawat di ICU memiliki beberapa faktor risiko yang meningkatkan venous thromboembolism (VTE). Venous thromboembolism merupakan komplikasi yang tersembunyi pada pasien sakit kritis yang dapat meningkatkan angka morbiditas dan mortalitas. Venous thromboembolism dapat dicegah dengan tromboprofilaksis yang sesuai dan adekuat. Pedoman pencegahan VTE dikembangkan dalam beberapa dekade salah satunya oleh American College of Chest Physicians (ACCP). Tujuan penelitian ini mengetahui kepatuhan berdasar ketepatan dan kecukupan pemberian tromboprofilaksis terhadap pedoman ACCP. Penelitian deskiripsi observasional retrospektif dilakukan pada Oktober–Desember 2018 terhadap 284 pasien yang dirawat di Unit Perawatan Intensif Rumah Sakit Dr. Hasan Sadikin Bandung periode Januari–Desember 2016. Secara keseluruhan proporsi pasien di ICU yang mendapatkan tromboprofilaksis, yaitu 36,1%. Angka kepatuhan pemberian profilaksis VTE di ICU berdasar pedoman ACCP adalah 21,5%. Pemberian profilaksis VTE yang tidak adekuat terdapat pada 12,4% pasien, sedangkan pemberian profilaksis yang tidak sesuai terdapat pada 2,2% pasien. Simpulan, kepatuhan pemberian tromboprofilaksis terhadap pedoman yang diterbitkan ACCP masih rendah. Adequacy and Accuracy of Venous Thromboembolism Prophylaxis based on American College of Chest Physicians Guideline at Intensive Care Unit of Dr. Hasan Sadikin General Hospital BandungCritically ill patients are patients with life-threatening conditions that require special treatment in the intensive care unit. Almost all critical patients admitted to the ICU have several risk factors that increase the occurrence of Venous thromboembolism (VTE). Venous thromboembolism is a hidden complication in critically ill patients that can increase morbidity and mortality. Venous thromboembolism can be prevented with appropriate and adequate thromboprophylaxis. Several thromboprophylaxis guidelines have been developed during the last decades, including the American College of Chest Physicians (ACCP) guideline. The purpose of this study was to determine the compliance to ACCP guideline by measuring the the accuracy and adequacy of thromboprophylaxis. This retrospective observational descriptive study was conducted from October–December 2018 on 284 patients treated in the Intensive Care Unit of Dr. Hasan Sadikin General Hospital Bandung. The overall proportion of patients in ICU who received thromboprophylaxis was 36.1%. The compliance rate of VTE prophylaxis in ICU based on ACCP guideline was 21.5%. Inadequate VTE prophylaxis was seen in 12.4% of patients while inappropriate prophylaxis was identified in 2.2% of patients. Hence, the compliance to standards on thromboprophylaxis based on the ACCP guideline is still low in this hospital. 

Venous Thrombosis and SARS-CoV-2

2021 ◽  
Author(s):  
Monika Zdanyte ◽  
Dominik Rath ◽  
Meinrad Gawaz ◽  
Tobias Geisler
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Vascular Endothelium ◽  
Arterial Thrombosis ◽  
Review Article ◽  
Prevention And Treatment ◽  
All Cause Mortality ◽  
Thrombotic Complications

AbstractSARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with high risk of venous and arterial thrombosis. Thrombotic complications, especially pulmonary embolism, lead to increased all-cause mortality in both intensive care unit and noncritically ill patients. Damage and activation of vascular endothelium, platelet activation, followed by thrombotic and fibrinolytic imbalance as well as hypercoagulability are the key pathomechanisms in immunothrombosis leading to a significant increase in thromboembolism in coronavirus disease 2019 (COVID-19) compared with other acute illnesses. In this review article, we discuss the incidence and prognosis, diagnosis, prevention, and treatment of venous thromboembolism in patients with COVID-19 disease, based on clinical experience and research available to date.

Sign in / Sign up

Export Citation Format

Share Document