PURPOSE: Pharmacological thromboprophylaxis (PTP) is strongly recommended in mechanically ventilated (MV) cancer patients because of their significant risk of venous thromboembolism (VTE). However, the potential for serious bleeding in these patients can preclude safe administration of PTP. We describe the demographic and clinical characteristics of ICU cancer patients on MV who did and who did not receive PTP.
METHODS: Data on all adult (> 18 yr) MV cancer patients admitted to a medical-surgical ICU during a 6-month period (September 2005-February 2006) were collected from an ICU database. Patients on MV for < 24 hours were excluded. Data variables included age, gender, MPM II score on ICU admission, type of VTE prophylaxis-mechanical (sequential compression device), IVC filter, or pharmacological (unfractionated heparin, low-molecular weight heparin or fondaparinux) and contraindications to PTP, vasopressor requirement, duration of MV, ICU and hospital length of stay, and mortality. Two groups of ICU patients were analyzed: Group A - on PTP ≥ 80% of MV days and Group B - on PTP ≤ 20% of MV days. Statistical analyses used were Student t-test and Fisher’s exact test. P < 0.05 was considered significant.
RESULTS: Of 262 ICU admissions, 139 (53%) required MV > 24h. While > 99% of all patients were on sequential compression devices and 29% had an IVC filter, only 34.5% received PTP. Patients on PTP (Group A) were older, less likely to require vasopressors, and had lower ICU and hospital mortality compared to patients not on PTP (Group B) (Table 1). The most common contraindications to PTP were active bleeding, thrombocytopenia, and perioperative status (Table 2).
CONCLUSION: Almost two-thirds of ICU cancer patients on MV at increased risk for VTE did not receive PTP. The major reasons for not receiving PTP were bleeding, thrombocytopenia, and surgical contraindications.
CLINICAL IMPLICATIONS: Earlier identification and routine screening Dopplers may be warranted in MV cancer patients unable to receive PTP in order to decrease potential VTE complications.
DISCLOSURE: Alina Dulu, None.