Author:
Waxman Michael J.,Griffin Daniel,Sercy Erica,Bar-Or David
Abstract
Abstract
Background
Recommendations are for nearly universal venous thromboembolism (VTE) prophylaxis in critically ill hospitalized patients because of their well-recognized risks. In those intensive care units (ICUs) where patient care is more uniformly directed, it may be expected that VTE prophylaxis would more closely follow this standard over units that are less uniform, such as open-model ICUs.
Methods
This was a retrospective cohort study on all patients aged 18+ admitted to an open ICU between 6/1/2017 and 5/31/2018. Patients were excluded if they had instructions to receive comfort measures only or required therapeutic anticoagulant administration. Prophylaxis administration practices, including administration of mechanical and/or pharmacologic prophylaxis and delayed (≥48 h post-ICU admission) initiation of pharmacologic prophylaxis, were compared between patients admitted to the ICU by the trauma service versus other departments. Root causes for opting out of pharmacological prophylaxis were documented and compared between the two study groups.
Results
One-hundred two study participants were admitted by the trauma service, and 98 were from a non-trauma service. Mechanical (98% trauma vs. 99% non-trauma, P = 0.99) and pharmacologic (54% vs. 44%, P = 0.16) prophylaxis rates were similar between the two admission groups. The median time from ICU admission to pharmacologic prophylaxis initiation was 53 h for the trauma service and 10 h for the non–trauma services (P ≤ 0.01). In regression analyses, trauma-service admission (odds ratio (OR) = 2.88, 95% confidence interval (CI) 1.21–6.83) and increasing ICU length of stay (OR = 1.13, 95% CI 1.05–1.21) were independently associated with pharmacologic prophylaxis use. Trauma-service admission (OR = 8.30, 95% CI 2.18–31.56) and increasing hospital length of stay (OR = 1.15, 95% CI 1.03–1.28) were independently associated with delayed prophylaxis initiation.
Conclusions
Overall, the receipt of VTE prophylaxis of any type was close to 100%, due to the nearly universal use of mechanical compression devices among ICU patients in this study. However, when examining pharmacologic prophylaxis specifically, the rate was considerably lower than is currently recommended: 54% among the trauma services and 44% among non-trauma services.
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine,Orthopedics and Sports Medicine,Surgery
Reference24 articles.
1. Al-Hameed FM. Venous thromboembolism prophylaxis: solutions are in our hands. Ann Thorac Med. 2011;6(3):105–6. https://doi.org/10.4103/1817-1737.82434.
2. American Heart Association. What is Venous Thromboembolism (VTE)? http://www.heart.org/HEARTORG/Conditions/VascularHealth/VenousThromboembolism/What-is-Venous-Thromboembolism-VTE_UCM_479052_Article.jsp. Published March 2017. Accessed 30 Apr 2020.
3. Malato A, Dentali F, Siragusa S, Fabbiano F, Kagoma Y, Boddi M, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus. 2015;13(4):559–68. https://doi.org/10.2450/2015.0277-14.
4. Miri M, Goharani R, Sistanizad M. Deep vein thrombosis among intensive care unit patients: an epidemiologic study. Emerg (Tehran). 2017;5(1):e13.
5. Eck RJ, Hulshof L, Wiersema R, Thio CHL, Hiemstra B, van den Oever NCG, et al. Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies. Crit Care. 2021;25(1):27. https://doi.org/10.1186/s13054-021-03457-0.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献