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Abstract: Poster Presentations |

A CLINICAL TRIAL TO COMPARE THROMBOPROPHYLAXIS OPTIONS IN THE MEDICAL ICU: CHALLENGES TO TREATMENT FREE TO VIEW

Tara Roque, MD; JulieAnne Thompson, MD; Tunay Kuru, MD*
Author and Funding Information

Georgetown University, Washington, DC


Chest


Chest. 2005;128(4_MeetingAbstracts):296S. doi:10.1378/chest.128.4_MeetingAbstracts.296S-a
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Abstract

PURPOSE:  To compare the efficacy of low-dose unfractionated heparin (LDUH) and enoxaparin for the prevention of deep venous thrombosis (DVT) in the medical ICU.

METHODS:  This was a prospective, randomized double-blinded trial to compare LDUH 5000 BID with enoxaparin. Patients were screened with a bedside Doppler ultrasound of the lower extremities at 48-72 hours of ICU admission and again at 7 days. All patients, older than 18 years of age, admitted to the MICU at Georgetown University Hospital were eligible. Exclusion criteria included pregnancy; contraindication to anticoagulation (e.g. uncontrolled hypertension,hemorrhagic stroke in the past 3 months, active gastrointestinal bleeding); ongoing anticoagulant therapy; intolerance to heparin; platelet count <80,000/ml; international normalized ratio (INR) > 2.0. Written informed consent was obtained prior to randomization.The primary endpoint was the diagnosis of DVT by Dopplers or death.

RESULTS:  From March 2003 to March 2004, 308 patients were screened. Thirty(9.75%) were enrolled. Two patients (6.7%), one in each study arm, were diagnosed with DVT by 72 hours; and one(3.3%)in the enoxaparin arm by 7 days.Patients were excluded for the following reasons: Active gastrointestinal bleeding: 59 (19%), intracranial hemorrhage: 18 (6%), hemorrhage from other sites (e.g. retroperitoneal): 4 (1%), already anticoagulated: 53 (17%), thrombocytopenia: 15 (5%), other coagulopathy: 27 (9%), acute renal failure and denied entry by treating physician: 19 (6%), Expected ICU stay <48 hours: 61 (20%), withdrawal of support within 48 hours of ICU admission: 4 (1%), patient or family declined enrollment: 14 (4.5%), miscellaneous (morbid obesity, aortic dissection, intolerance to heparin: 4 (1%).

CONCLUSION:  Despite medical prophylaxis, 10% of MICU patients developed DVT. Almost half the patients (49%, excluding those with MICU length of stay <48 hours and those already on anticoagulation) had contraindications to medical thromboprophylaxis.

CLINICAL IMPLICATIONS:  Incidence of DVT in the MICU remains high, despite medical prophylaxis. Therefore, for MICU patients, combined medical and mechanical thromboprophylaxis should be considered. Furthermore, a significant proportion of MICU patients have contraindications to medical thromboprophylaxis. For this patient population, routine screening Dopplers may be warranted.

DISCLOSURE:  Tunay Kuru, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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