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Original Research |

Omission of Early Thromboprophylaxis and Mortality in Critically Ill PatientsThromboprophylaxis and Mortality: A Multicenter Registry Study

Kwok M. Ho, PhD; Shaila Chavan, MSPH; David Pilcher, MBBS; VTE Point Prevalence Investigators for the Australian and New Zealand Intensive Care Research Centre
Author and Funding Information

From the Department of Intensive Care Medicine and School of Population Health (Dr Ho), Royal Perth Hospital and University of Western Australia, Perth, WA; the Centre for Outcome and Resource Evaluation (Ms Chavan), Australian and New Zealand Society of Intensive Care, Melbourne, VIC; and the Department of Intensive Care (Dr Pilcher), Alfred Hospital, Melbourne, VIC, Australia.

Correspondence to: Kwok M. Ho, PhD, Intensive Care Unit, Royal Perth Hospital, University of Western Australia, Wellington St, Perth, WA, 6000, Australia; e-mail: kwok.ho@health.wa.gov.au

Data are given as No. (%) unless otherwise indicated. APACHE = Acute Physiology and Chronic Health Evaluation; IQR = interquartile range.

a

Data from 6,615 patients were available.

b

Median value of APACHE III score or predicted mortality.

Nagelkerke R2 and area under the receiver operating characteristic curve of the final multivariate model were 0.396 and 0.885 (95% CI, 0.882-0.888), respectively. P values associated with thromboprophylaxis status in all forward stepwise models were < .001. See Table 1 legend for expansion of abbreviation.

P values associated with thromboprophylaxis status in all subgroup analyses were <.001. See Table 1 legend for expansion of abbreviation.

Data are presented as No. (%) unless otherwise indicated. See Table 1 legend for expansion of abbreviations.

Nagelkerke R2 and area under the receiver operating characteristic curve of the final multivariate model were 0.401 and 0.883 (95% CI, 0.881-0.886), respectively. See Table 1 legend for expansion of abbreviation.

For editorial comment see page 1401

Funding/Support: This study was funded by the Department of Intensive Care Medicine, Royal Perth Hospital.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


For editorial comment see page 1401

For editorial comment see page 1401

Funding/Support: This study was funded by the Department of Intensive Care Medicine, Royal Perth Hospital.

Funding/Support: This study was funded by the Department of Intensive Care Medicine, Royal Perth Hospital.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1436-1446. doi:10.1378/chest.11-1444
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Background:  VTE is a preventable cause of death within hospitals. This study aimed to assess the association between omission of early thromboprophylaxis for > 24 h after ICU admission and mortality in critically ill patients.

Methods:  This study involved 175,665 critically ill adult patients admitted to 134 ICUs in Australia and New Zealand between 2006 and 2010.

Results:  The crude ICU and hospital mortality in patients who did not receive thromboprophylaxis within 24 h of ICU admission was higher than those who were treated with early thromboprophylaxis (7.6% vs 6.3%, P = .001; 11.2% vs 10.6%, P = .003, respectively), despite the former patients being associated with a slightly lower acuity of illness (mean APACHE [Acute Physiology and Chronic Health Evaluation] III model predicted mortality, 13% vs 14%; P = .001). The association between omission of early thromboprophylaxis and hospital mortality remained significant after adjusting for other covariates (OR, 1.22; 95% CI, 1.15-1.30; P = .001), particularly for patients with multiple trauma, sepsis, cardiac arrest, and preexisting metastatic cancer. The estimated attributable mortality effect of omitting early thromboprophylaxis for patients with multiple trauma, sepsis, cardiac arrest, and preexisting metastatic cancer was 3.9% (95% CI, 2.2-5.6), 8.0% (95% CI, 5.6-10.4), 15.4% (95% CI, 11.1-19.8), and 9.4% (95% CI, 6.4-12.4), respectively.

Conclusions:  Omission of thromboprophylaxis within the first 24 h of ICU admission without obvious reasons was associated with an increased risk of mortality in critically ill adult patients.

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