Venous Thromboembolism Prophylaxis in Intensive Care Unit Patients: Findings From the Brazilian Registry

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 826A
Author(s):  
Ana Thereza Rocha ◽  
Edison Paiva ◽  
Eduardo Emmanoel
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis

Standard Dosing of Enoxaparin for Venous Thromboembolism Prophylaxis is Not Sufficient for Most Patients within a Trauma Intensive Care Unit

2015 ◽  
Vol 81 (9) ◽  
pp. 889-892 ◽  
Author(s):  
Jack W. Rostas ◽  
Sidney B. Brevard ◽  
Naveed Ahmed ◽  
John Allen ◽  
Derek Thacker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Abdominal Wall ◽  
Wall Thickness ◽  
Fluid Balance ◽  
Obese Patients ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis ◽  
Subcutaneous Enoxaparin

Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled in this study. Trough antiXa levels were obtained and any level less than 0.1 IU/mL was considered subtherapeutic and the final dosage requirement was recorded. Body mass index (BMI), abdominal wall thickness, and fluid balance were collected. Thirty-four patients were prospectively enrolled in the study, 14 (50%) of which had a BMI >30. Sixty-five per cent of obese patients were initially nontherapeutic, compared with 53 per cent of the nonobese ( P = 0.73). However, elevated BMI ( P < 0.05) and abdominal wall thickness ( P < 0.05) correlated to an increased final dose required to attain an anti Xa ≥0.1 when not initially therapeutic, whereas fluid balance demonstrated no correlation ( P = 0.232). Subcutaneous enoxaparin dosing of 30 mg b.i.d. is not sufficient for the majority adult trauma patients in the intensive care unit, regardless of BMI. When enoxaparin 30 mg b.i.d. is initially subtherapeutic, obese patients may require a larger dose necessary to achieve necessary anticoagulation.

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.

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.

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