Medical intensive care unit (MICU) patients frequently have multiple risk factors (RF) for venous thromboembolism (VTE) and some contraindications for anticoagulation. VTE risk-assessment tools (RAT) and continuous medical education may improve evaluation of RF for thrombosis and bleeding and the adequacy of VTE prophylaxis of MICU patients.
We reviewed the records of 200 consecutive adult patients admitted to our 24-bed private hospital MICU after one year of educational intervention with lectures to the MICU staff and distribution of VTE RAT. We evaluated data on admission diagnoses, RF for thrombosis and bleeding, and the rate of prophylaxis used, comparing it to the rate of prophylaxis of 45 patients surveyed three years before (58%) in our MICU.
Of the 200 MICU patients, 52.5% were female, mean age was 67 ± 16 years, 95.5% had VTE RF (not including the MICU admission itself), and their MICU stay was 9 ± 27 days (median 3). The primary MICU diagnosis was a RF for VTE in 73% and the most frequent RF are shown in table 1. Patients had an average/patient of 4 ± 1.4 RF for VTE. RF for bleeding were present in 32.5% (average/patient 0.4 ± 0.7). Prophylaxis was used in 93.5% for an average of 15 ± 27 days (median 5): low-molecular-weight-heparin (HBPM) in 53%, unfractionated-heparin (UFH) in 7.5%, elastic stockings in 34.2% and a combination in 12.8%. Heparin use was more common in patients without bleeding RF (66% vs. 34%, p < 0.05), and mechanical prophylaxis, in those with bleeding RF (66% vs. 34%, p < 0.0001). Doses of HBPM were adequate (enoxaparin 40mg/day) in 87% and of UFH (5000IU 8–8h) in 57%.
Most MICU patients have high risk for VTE and should receive prophylaxis. After the educational intervention, there was an increase in the rate of VTE prophylaxis utilization and an improvement in adequacy of choice and doses of prophylaxis.
Strategies based on distribution of VTE RAT and educational lectures might improve awareness and adequacy of VTE prophylaxis in MICU patients.
Ana Thereza Rocha, Consultant fee, speaker bureau, advisory committee, etc. I am a speaker and member of advisory board for Sanofi-Aventis; No Product/Research Disclosure Information