Abstract
Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a severe complication in critically ill patients generally affected by multiorgan disfunction associated with immobilization also prolonged.
Nowadays, VTE prophylaxis is included in the requirements of hospital accreditation and evaluation of the maintenance of standards of quality of care. ICU patients are characterized by a dynamic day-to-day variation both of thromboembolic that bleeding risk and DVT incidence in presence of thromboprophylaxis ranges between 5 and 15 %.
Patient-centered methods for the assessment of both thrombotic and bleeding risk are recommended because pre-existent factors to ICU admission, diagnosis, emerging syndromes, invasive procedures and pharmacological treatments daily induce important changes in clinical condition.
General consensus currently establishes use of heparin in pharmacological prophylaxis at the time of admission to the ICU and the temporary suspension of heparin in patients with active bleeding or severe (<50,000/cc) thrombocytopenia. Individualized thromboprophylaxis regimens were proposed but there is still no consensus based on evidence.
DVT diagnosis is not clinical but imaging-based and in each ICU data on DVT incidence (DVT diagnosed 72 h after ICU admission) should be obtained by weekly ultrasound screening standardized for the anatomical sites of compression used, taking into account the persistence of DVT-risk throughout ICU stay. A role for mechanical thromboprophylaxis by elastic stockings or pneumatic compression was reported but no general consensus was reached about its use at the best. Much work has to be done but ICU remain the last frontier for VTE prophylaxis.
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References
Geerts W, Selby R (2003) Prevention of venous thromboembolism in the ICU. Chest 124(6 Suppl):357S
McLeod AG, Geerts W (2011) Venous thromboembolism prophylaxis in critically ill patients. Crit Care Clin 27(4):765–780
Cook D, Crowther M, Meade M et al (2005) Deep vein thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med 33(7):1565–1571
Boddi M, Barbani F, Abbate R, Bonizzoli M, Batacchi S, Lucente E, Chiostri M, Gensini GF, Peris A (2010) Reduction in deep vein thrombosis incidence in intensive care after a clinician education program. J Thromb Haemost 8:121–128
Moser KM, Le Moine JR, Natchwey FJ, Spragg RG (1981) Deep venous thrombosis and pulmonary embolism. Frequency in respiratory intensive care unit. JAMA 246(13):1422–1424
Cade JF (1982) High risk of the critically ill for venous thromboembolism. Crit Care Med 10(7):448–450
Kapoor M, Kupfer YY, Tessler S (1999) Subcutaneously heparin prophylaxis significantly reduces the incidence of venous thromboembolic events in critically ill. Crit Care Med 27(Suppl 12):A69
Fraisse F, Holzapfel L, Couland JM et al (2000) The Association of Non-University Affiliated Intensive Care Specialist Physician of France. Naproparin in the prevention of deep vein thrombosis in acute decompensated COPD. Am J Respir Crit Care Med 161(4, Pt 1):1109–1114
Kahn SR, Lim W, Dunn AS, et al (2012) American College of chest physicians. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians. Evidence-Based Clinical Practice Guidelines. Chest 141(2, Suppl):e1955–e2265
Geerts WH, Pineo GF, Bergqvist D, Lassen CCW, Ray J (2004) Prevention of venous thromboembolism:the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:338S–400S
Boonyawat K, Crowther MA (2015) Venous thromboembolism prophylaxis in critically ill patients. Semin Thromb Hemost 41:68–74
Wells PS, Owen C, Doucette S, Fergusson D, Tran H (2006) Does this patient have deep vein thrombosis? JAMA 295:199–207
Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M et al (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8(11):2450–2457
Caprini JA, Arcelus JI, Reyna JJ (2001) Effective risk stratification of surgical and not surgical patients for venous thromboembolic disease. Semin Hematol 38:12S–19S
Katsios CM, Donadini M, Meade M, Mehta S, Granton J, Kutsiogiannis J et al (2014) Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients. Can Respir J 21(1):36–42
Williamson DR, Albert M, Heels-Ansdell D, Arnold DM, Lauzier F, Zarychanski R et al (2013) Thrombocytopenia in critically ill patients receiving thromboprophylaxis. Chest 144(4):1207–1215
Lauzier F, Arnold DM, Rabbat C, Heels-Ansdell D, Zarychanski R, Dodek P et al (2013) Risk factors and impact of major bleeding in critically ill patients receiving heparin thromboprophylaxis. Intensive Care Med 39:2135–2143
Crowther MA, Cook DJ, Griffith LE, Devereaux PJ, Rabbat CC, Clarke FJ, Hoad N, McDonald E, Meade MO, Guyatt GH, Geerts WH, Wells PS (2005) Deep venous thrombosis: clinically silent in the intensive care unit. J Crit Care 20(4):334–340
Kearon C, Ginsberg JS, Hirsh J (1998) The role of venous ultrasonography in the diagnosis of suspected deep vein thrombosis and pulmonary embolism. Ann Intern Med 129:1044–1049
Blann AD, Lip GYH (2006) Venous thromboembolism. BMJ 332:215–219
Shellong SM, Beyer J, Kakkar AK, Halbritter K, Eriksson BI, Turpie ACG et al (2007) Ultrasound screening for asymptomatic deep vein thrombosis after major orthopedic surgery: the VENUS study. J Thromb Haemost 5:1431–1437
Cook DJ, Rocker G, Meade M, Guyatt G, Geerts WH (2005) Andersond, et al. PROTECT Investigators; Canadian Critical Care Trials Group. Prophylaxis of Thromboembolism in Critical Care (PROTECT) Trial: a pilot sudy. J Crit Care 20:364–372
Hirsch DR, Ingenito EP, Goldhaber SZ (1995) Prevalence of deep venous thrombosis among patients in medical intensive care. JAMA 274:335–337
The Intensive Care Society (2008) Guidelines for Venous Thromboprophylaxis in Critical Care. http://www.ics.ac.uk/icmprof/downloads/2008102336_Thromboprophylaxis%2027%2010%2008.pdf
Pierce CA, Haut ER, Kardooni S, Chang DC, Efron DT, Haider A, Pronovost PJ (2008) Cornwell EE 3rd.Surveillance bias and deep vein thrombosis in the national trauma data bank; the more we look, the more we find. J Trauma 64:932–936
Boddi M, Cecchi A, Bonizzoli M, Barbani F, Franci A, Anichini V, Batacchi S, Parodo J, Gensini GF, Peris A (2014) Follow-up after four-year quality improvement program to prevent inferior limb deep vein thrombosis in intensive care unit. Thromb Res 134(3):578–583
Geerts W(1), Cook D, Selby R, Etchells E (2002) Venous thromboembolism and its prevention in critical care. J Crit Care 17(2):95–104
Bonizzoli M, Batacchi S, Cianchi G, Zagli G, Lapi F, Tucci V et al (2011) Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 37(2):284–289
Lamontagne F, McIntyre L, Dodek P, Heels-Ansdell D, Meade M, Pemberton J et al (2014) Nonleg venous thrombosis in critically ill adults: a nested prospective cohort study FREE.JAMA. Intern Med 174(5):689–696
Migliaccio ML, Zagli G, Cianchi G, Lazzeri C, Bonizzoli M, Cecchi A, Anichini V, Gensini GF, Peris A (2013) Extracorporeal membrane oxygenation in brain-death organ and tissues donors: a single-centre experience. Br J Anaesth 111(4):673–674
Mammen EF (1992) Pathogenesis of venous thrombosis. Chest 102:640S–644S
Miranda AR, Hassouna HI (2000) Mechanisms of thrombosis in spinal cord injury. Hematol Oncol Clin North Am 14:401–416
Ibrahim EH, Irequi M, Prentice D, Sherman G, KollefMH SW (2002) Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis. Crit Care Med 30:771–774
Cook DJ, Crowther MA, Geerts WH (2005) On the need for a workshop on venous thromboembolism in critical care. J Crit Care 20(4):306–308
Garcia-Olivares P, Guerrero JE, Galdos P, Carriedo D, Murillo F (2014) Rivera A.PROF-ETEV study: prophylaxis of venous thromboembolic disease in critical care units in Spain. Intensive Care Med 40:1698–1708
Laporte S, Mismetti P (2010) Epidemiology of thrombotic risk factors:the difficulty of using clinical trials to develop a risk assessment model. Crit Care Med 38(2 Suppl):S10–S17
Welsby I, Ortel T (2015) Is the time for individualized thromboprophylaxis regimens in ICU? Crit Care Med 43:500–501
Alhazzani W, Lim W, Jaeschke RZ, Murad MH, Cade J, CooK DJ (2013) Heparin thromboprophylaxis in medical-surgical critically ill patients:a systematic review and meta-analysis of randomized trials. Crit Care Med 41(9):2088–2098
Rajasekhar A, Beyth R, Crowther MA (2012) Newer anticoagulants in critically ill patients. Crit Care Clin 28:427–451
De A, Roy P, Garg VK, Pandey NK (2010) Low-molecular-weight –heparin and unfractionated heparin in prophylaxis against deep vein thrombosis in critically ill patients undergoing major surgery. Blood Coagul Fibrinolysis 21(1):57–61
Cook D, Meade M, Guyatt G et al (2011) PROTECT Investigators for the Canadian Critical Care Trials Group and the Austalian and New Zeland Intensive Care Society Clinical Trials Group. Deltaparin versus unfractionated heparin in critically ill patients. N Engl J Med 364(14):1305–1314
Goldhaber SZ, Kett DH, Cusumano CJ et al (2000) Low molecular weight heparin versus minidose unfractionated heparin for prophylaxis against venous thromboembolism in medical intensive care unit patients: A randomized controlled trial. J Am Coll Cardiol 35(suppl):325 A
Lin W, Meade M, Lauzier F, Zarychanski R, Mehta S (2015) Lamontagne F for the PROTECT Trial Group. Failure of anticoagulant thromboprophylaxis:risk factors in medical-surgical critically ill patients. Crit Care Med 43:4001–4410
Beitland S, Sandven I, Kjærvik LK, Sandset PM, Sunde K, Eken T (2015) Thromboprophylaxis with low molecular weight heparin versus unfractionated heparin in intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med [Epub ahead of print]
Wang C, Chi C, Guo L, Wang X, Sun J, Liu S et al (2014) Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis. Crit Care 18:563–572
Severinsen MT, Kristensen SR, Johensen SP et al (2009) Anthropometry, body fat, and venous thromboembolism.A Danish follow-up study. Circulation 120:1850–1857
Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK (2011) Factors at admission associated with Bleeding risk in medical patients.Findings from the IMROVE Investigators. Chest 139:69–79
Cohen AT, Spiro TE, Spyropoulos AC, MAGELLAN Steering Committee (2013) Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 368(20):1945–1946. doi:10.1056/NEJMc1303641
Goldhaber SZ(1), Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, Weitz JI (2011) ADOPT trial investigators. N Engl J Med. 365(23):2167–2177. doi:10.1056/NEJMoa1110899
Vignon P, Dequin PF, Renault A et al (2013) Clinical Research in Intensive Care and Sepsis Group ( CRICS Group). Intermittent pneumatic compression to prevent venous thromboembolism in patients at high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial. Intensive Care Med 39(5):872–880
Cipolle MD, Wojcik R, Seislove E, Waaser T, Pasquale MD (2002) The role of surveillance duplex scanning in preventing venous thromboembolism in trauma patients. J Trauma 52:453–462
Zhang C, Zeng W, Zhou H et al (2011) The efficacy of intermittent pneumatic compression in the prevention of venous thromboembolism in medical critically ill patients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 23(9):563–565
Arabi YM, Khedr M, Dara SI et al (2013) Use of intermittent pneumatic compression and not graduated compression stockings is associated with lower incident VTE in critically ill patients: a multiple propensity score analysis. Chest 144(1):152–159
Sharif-Kashani B, Shahabi P, Raeissi S, Behzadnia N, Shoaraka A, Shahrivari M et al (2012) ProphylAxis for VenouS ThromboembolIsm in hospitalized patients: the MASIH study. Clin Appl Thromb Hemost 18(5):462–468
Ho KM, Chavan S, Pilcher D (2011) Omission of early thromboprophylaxis and mortality in critically ill patients: a multi center registry study. Chest 140(6):51–57
McMullin J, Cook D, Griffith L et al (2006) Minimizing errors of omission: behavioural re-enforcement of heparin to avoid venous emboli:the BEHAVE study. Crit Care Med 8(1):121–128
Teixera PG, Inaba K, Dubose J et al (2013) Measurable outcomes of quality improvement using a daily quality rounds checklist:two year prospective analysis of sustainability in a surgical intensive care unit. J Trauma Acute Care Surg 75(4):717–721
Robinson S, Zincuk A, Larsen UL et al (2013) A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients:A double-blinded, randomized controlled trial. Crit Care 17:R75–R79
Crowther MA, Cook DJ (2008) Thromboprophylaxis in medical-surgical critically ill patients. Curr Opin Crit Care 14:520–523
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Boddi, M., Peris, A. (2016). Deep Vein Thrombosis in Intensive Care. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_114
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DOI: https://doi.org/10.1007/5584_2016_114
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