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A Multinational Comparison of Prophylaxis Practices for Venous Thromboembolism During Medical Intensive Care: Findings from IMPROVE FREE TO VIEW

Gordon FitzGerald, PhD; Fred A. Anderson, Jr, PhD; Victor F. Tapson, MD*; James B. Froehlich, MD MPH; Franco Piovella, MD; Alex C. Spyropoulos, MD; Herve Decousus, MD; Jean-Francois Bergmann, MD; Beng H. Chong, MBBS, PhD; Ajay K. Kakkar, MB, PhD; Geno J. Merli, MD; Manuel Monreal, MD; Mashio Nakamura, MD; Ricardo Pavanello, MD; Mario Pini, MD; Alexander G. Turpie, MD; Rainer B. Zotz, MD; for the IMPROVE Investigators
Author and Funding Information

Duke University Medical Center, Durham, NC


Chest


Chest. 2004;126(4_MeetingAbstracts):784S. doi:10.1378/chest.126.4_MeetingAbstracts.784S
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Abstract

PURPOSE:  Patients admitted to a medical intensive care unit (ICU) are at high risk of venous thromboembolism (VTE). Data from the IMPROVE registry were used to compare VTE prophylaxis practice patterns in hospitalized, acutely ill medical patients admitted to an ICU with patients admitted to non-ICU beds.

METHODS:  Beginning in July 2002, consecutive patients were enrolled who were ≥18 years old and hospitalized for ≥3 days with an acute medical illness. Exclusion criteria included therapeutic antithrombotic/thrombolytics at admission, major surgery/trauma within 3 months of admission, and VTE treatment within 24 hours of admission.

RESULTS:  Data are presented from 3,727 patients enrolled through March 31, 2004 from 33 hospitals in 11 countries, of whom 239 (6.4%) were admitted to an ICU. A higher proportion of US patients were admitted to ICU compared with non-US patients (12% v. 4%, p<0.0001). ICU patients in the US were older than non-ICU US patients (median 61 v. 55 years, p=0.04), had a higher in-hospital death rate (13% v. 1%, p<0.0001), were more likely to receive intermittent pneumatic compression (IPC; 36% v. 11%, p<0.0001), and had lower bleeding rates (6% and 2%, p=0.01). ICU patients outside of the US were younger than non-US, non-ICU patients (median 67 v. 73 years, p=0.05), more likely to receive low-molecular-weight heparin (LMWH; 53% v. 30%, p<0.0001) or unfractionated heparin (UFH; 13% v. 6%, p=0.01), had a higher bleeding rate (13% v. 3%, p<0.0001), and had similar in-hospital death rates (9% and 6%, p=0.17). Suspected VTE was more common amongst ICU than non-ICU patients (23% v. 10%, p<0.0001).

CONCLUSION:  ICU patients were more likely to receive VTE prophylaxis than other patients, with IPC prophylaxis more likely in US ICU patients, while LMWH and UFH were more likely in non-US ICU patients.

CLINICAL IMPLICATIONS:  ICU patients are at a higher risk of bleeding, VTE, and death compared to other hospital patients, making ICU patients a particularly challenging group for selecting and managing VTE prophylaxis.

DISCLOSURE:  V.F. Tapson, IMPROVE is funded by an unrestricted educational grant

Wednesday, October 27, 2004

10:30 AM- 12:00 PM


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