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Pulmonary Vascular Disease |

Venous Thromboembolism Prophylaxis in Intensive Care Unit Patients: Findings From the Brazilian Registry

Ana Thereza Rocha, MD; Edison Paiva, MD; Eduardo Emmanoel
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Universidade Federal de Sao Paulo, Sao Paulo, Brazil


Chest. 2014;146(4_MeetingAbstracts):826A. doi:10.1378/chest.1994424
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Approximately one-forth of hospitalized patients passes through an intensive care unit (ICU) while acutely ill. Venous thromboembolism (VTE) in the ICU is associated with poorer outcomes; hence, starting appropriate VTE prophylaxis is essential. The profilaxiadetev.org is an on-line registry linked to the FMUSP that offers VTE risk-assessment for patients in Brazilian hospitals initiating VTE prophylaxis programs. We evaluated this registry focusing on ICU patients.

METHODS: We evaluated data from cross-sectional audits in 113 participating hospitals from 6/2008 till 2/2014. VTE risk factors (RF), contra-indications (CI) for pharmacologic prophylaxis, and use of prophylaxis were entered by local hospitals. The risk-assessment for surgical patients was based on the 2008 American College of Chest Physicians (ACCP) guidelines and for medical patients was based on the Brazilian Guideline for VTE prophylaxis (2006).

RESULTS: A total of 66,221 patients were registered; 18,4% (12,216) were ICU patients; 50% were female, 73% had age ≥40, and 60% age ≥ 55 years-old; 75% (9,111) were medical cases, 90% of which had high risk for VTE; 25% (3,105) were surgical cases: 81% were high risk and 11% moderate risk patients. The vast majority (97% surgical and 99% medical) had at least one RF for VTE. The most common (Table 1) were age >55, infection, venous catheters, respiratory insufficiency, stroke, MI, heart failure, obesity and previous VTE. Relative CI for prophylaxis were present in 18% (active bleeding 8%, coagulopathy 3%, severe renal insufficiency 2%, use of other anticoagulant 2%, other 2%). VTE prophylaxis was used in 71%: pharmacological in 59% (unfractionated heparin 6%, low-molecular weight heparins 83%, other in 11%) and mechanical in 12%; combined methods in 20%. Mechanical methods included intermittent compression devices 10%, elastic stockings 13% and physiotherapy to the legs in 87%. Complications of prophylaxis were registered in only 0,2% of the cases.

CONCLUSIONS: The vast majority of ICU patients in Brazil have high risk for VTE and 71% received prophylaxis. Routine evaluation of risk upon ICU admission using an opt-out rule for prophylaxis may improve implementation of guidelines and avoid complications, once 18% present some CI for pharmacological prophylaxis.

CLINICAL IMPLICATIONS: Daily evaluation of VTE and bleeding risks is paramount for the adequacy of prophylaxis in ICU patients. Providing instructions for continuing prophylaxis may be an opportunity for improvement upon ICU discharge.

DISCLOSURE: Ana Thereza Rocha: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Edison Paiva: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Eduardo Emmanoel: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker

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