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Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis

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Abstract

Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.

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Abbreviations

ACCP:

American College of Chest Physicians

CT:

computed tomography

CTPA:

computed tomographic pulmonary angiography

CUS:

compression ultrasonography

DVT:

deep venous thrombosis

GCS:

graduated compression stockings

IPC:

intermittent pneumatic compression

LMWH:

low molecular weight heparin

PE:

pulmonary embolism

PESI:

Pulmonary Embolism Severity Index

RCT:

randomized controlled trial

sPESI:

simplified Pulmonary Embolism Severity Index

TEE:

transesophageal echocardiography

TTE:

transthoracic echocardiography

UFH:

unfractionated heparin

VTE:

venous thromboembolism

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Acknowledgements

The authors thank Céline Feger, MD (EMIBiotech) for her editorial assistance.

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Authors and Affiliations

  1. UJF-Grenoble I, University Hospital Albert Michallon, Medical Intensive Care Unit, Grenoble, F-38041, France

    Clémence Minet, Leila Potton, Agnès Bonadona, Rébecca Hamidfar-Roy, Claire Ara Somohano, Maxime Lugosi, Jean-Charles Cartier, Carole Schwebel & Jean-François Timsit

  2. Department of Radiology, UJF-Grenoble I, University Hospital Albert Michallon, Grenoble, F-38041, France

    Gilbert Ferretti

  3. UJF-Grenoble I, University Hospital Albert Michallon, U823 Institut Albert Bonniot, Team 11: Outcome of mechanically ventilated patients and airway cancers, Grenoble, F-38041, France

    Gilbert Ferretti & Jean-François Timsit

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  1. Clémence Minet
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Correspondence to Clémence Minet.

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Minet, C., Potton, L., Bonadona, A. et al. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Crit Care 19, 287 (2015). https://doi.org/10.1186/s13054-015-1003-9

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