PURPOSE: Venous thromboembolism (VTE) is a common complication of critical illness. To compare the efficacy of single modality of DVT prophylaxis (heparin or pneumatic boots) with combined modalities of DVT prophylaxis (heparin and pneumatic boots) in the prevention of DVT in medical intensive care unit (MICU).
METHODS: This is a prospective randomized clinical trial of patients admitted to an adult MICU. Patients with expected length of stay of 3 or more days were randomized to either single or combined modalities of DVT prophylaxis. Before randomization patients had lower extremity doppler to rule out pre-existing DVT. This was repeated on day-3 and day-7 or at the time of discharge from MICU if it is less than 7 days. The primary efficacy end point was a diagnosis of DVT on day 7 or day of discharge from ICU if less than 7 days.
RESULTS: We screened a total of 1200 patients during a 20-month period . A total of 453 patients met the inclusion criteria. A total of 96 patients were enrolled. The number of patients randomized to combined and single modality was (42/96; 43%) and (54/96; 56%) respectively. In the single modality group, an equal number of patients were on heparin (27/54; 50%) or pneumatic boots (27/54; 50%). The total number of patients who completed 7 days of MICU stay was 59/96 (61%). The total number of patients discharged before 7 days from MICU was 30/96 (31%). Five patients (5/96; 5%) withdrew consent and two patients (2/96; 2%) expired before day 3. During the observed period a total of 7 patients developed DVT: Four patients (3 on day 3, 1 on day 7) in combined modality, and 3 patients (all were on heparin, on day 7) in single modality.
CONCLUSION: We did not find any statistically significant difference (p= 0.5) in efficacy between single or combined modality of DVT prophylaxis in MICU patients. Despite appropriate prophylaxis 7% of observed patients developed DVT.
CLINICAL IMPLICATIONS: In spite of appropriate prophylaxis critically ill patients develop DVT.
DISCLOSURE: Rani Kumaran, None.