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The Incidence and Prophylaxis of Venous Thrombo-Embolism in a Community Intensive Care Unit FREE TO VIEW

John G. Muscedere, MD*; Louise Roberts, RN; Julie Trpkovski, RN; Carol Diemer, RN; Deborah Cook, MD
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Hotel-Dieu Grace Hospital, Windsor, ON, Canada


Chest. 2004;126(4_MeetingAbstracts):876S. doi:10.1378/chest.126.4_MeetingAbstracts.876S-a
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PURPOSE:  Venous thrombo-embolism (VTE) can be a life threatening complication of critical illness. Screening studies have demonstrated high rates of VTE in the ICU. There is little information on the rates of clinically diagnosed VTE and there is even less information on VTE rates in community ICU’s. The clinical diagnosis of VTE is problematic in the ICU since the signs and symptoms of VTE may be absent. Most studies of VTE have been done in teaching centers and the generalisability to community ICU’s is questionable. The purpose of this study was to study the incidence of clinically diagnosed VTE and thromboprophylaxis in a tertiary community ICU.

METHODS:  In a tertiary care medical, surgical, trauma and neurosurgical community ICU we conducted a retrospective chart review, identifying 600 consecutive, adult admissions who were admitted to the ICU > 48 hours, without an admission diagnosis of VTE, between January 2001 and December 2002. The primary endpoints were: VTE events, VTE diagnostic studies and prophylaxis regimens. The charts were reviewed for the whole hospital stay.

RESULTS:  Patient characteristics were as follows: Age 59.5 ± 0.7 years, Apache II score 17.0 ±0.3, ICU LOS 9.3 ±0.3 days and overall hospital mortality rate was 22.2%. The total VTE rate (ICU + hospital) was 8.3% (ICU 3.0%, hosp 5.7%). The VTE rates varied dramatically between diagnostic catagories. For medical/surgical patients the rate was 4.8% (ICU 2.6%, hosp. 2.5%), for trauma patients 6.1% (ICU 3.0%, hosp. 3.2%), for neurosurgical patients 18.2% (ICU 4.1%, hosp. 15.3%). See tableProphylaxis (% of days with prophylaxis)LDUH (Low Dose Unfractionated Heparin)LMWH (Low molecular weight heparin)Mechanical (pneumatic compression stockings)TotalICU (all patients)11.2 ± 1.142.1 ± 1.734.3 ± 2.387.6 ± 3.1Ward (all patients)14.4 ± 1.441.9 ± 1.93.5 ± 0.659.8 ± 2.4ICU (Med-surgical patients)58.0 ± 2.010.3 ± 1.317.6 ± 1.785.9 ± 2.9Ward (Med-surgical patients)50.6 ± 2.49.4 ± 1.41.3 ± 0.561.3 ± 3.2ICU (Neuro-surgical patients)9.9 ± 1.85.8 ± 1.571.0 ± 2.886.7 ± 3.7Ward (Neuro-surgical patients)26.4 ± 3.315.9 ± 2.910.3 ± 2.052.6 ± 4.8ICU (Trauma patients)20.9 ± 3.926.5 ± 4.523.6 ± 4.471.0 ± 7.4Ward (Trauma patients)27.0 ± 5.237.9 ± 5.61.8 ± 1.166.7 ± 7.7for thromboprophylaxis regimens and rates.

CONCLUSION:  Among critically ill patients, VTE risk a) is significant b) varies depending on the ICU population c) occurs despite thromboprophylaxis and d) continues as critical illness resolves and thromboprohylaxis rates drop. Further research on the diagnosis of VTE and better thromboprophylaxis regimens are neeeded.

CLINICAL IMPLICATIONS:  VTE remains a significant problem in critically ill patients, occuring despite thromboprophylaxis. Increased attention to prevention is needed in the ICU, as well as after ICU discharge.

DISCLOSURE:  J.G. Muscedere, None.

Wednesday, October 27, 2004

12:30 PM- 2:00 PM




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