PROF-ETEV study: prophylaxis of venous thromboembolic disease in critical care units in Spain

Abstract

Purpose

Venous thromboembolic disease (VTE) in critically ill patients has a high incidence despite prophylactic measures. This fact could be related to an inappropriate use of these measures due to the absence of specific VTE risk scores. To assess the current situation in Spain, we have performed a cross-sectional study, analyzing if the prophylactic measures were appropriate to the patients’ VTE risk.

Methods

Through an electronic questionnaire, we carried out a single day point prevalence study on the VTE prophylactic measures used in several critical care units in Spain. We performed a risk stratification for VTE in three groups: low, moderate–high, and very high risk. The American College of Chest Physicians guidelines were used to determine if the patients were receiving the recommended prophylaxis.

Results

A total of 777 patients were included; 62 % medical, 30 % surgical, and 7 % major trauma patients. The median number of the risk factors for VTE was four. According to the proposed VTE risk score, only 2 % of the patients were at low risk, whereas 83 % were at very high risk. Sixty-three percent of patients received pharmacological prophylaxis, 12 % mechanical prophylaxis, 6 % combined prophylaxis, and 19 % did not receive any prophylactic measure. According to criteria suggested by the guidelines, 23 % of medical, 71 % of surgical, and 70 % of major trauma patients received an inappropriate prophylaxis.

Conclusions

Most critically ill patients are at high or very high risk of VTE, but there is a low rate of appropriate prophylaxis. The efforts to improve the identification of patients at risk, and the implementation of appropriate prevention protocols should be enhanced.

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Conflicts of interest

Pablo Garcia Olivares and Jose Eugenio Guerrero Sanz have participated in several symposiums about venous thromboembolic disease in critically ill patients, organized by Covidien Spain S.L.

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Corresponding author

Correspondence to Pablo García-Olivares.

Additional information

For the PROF-ETEV study investigators.

The members of the PROF-ETEV study investigators are given in the “Appendix”.

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Appendix

Appendix

Coordinating Committee PROF-ETEV study:

Pablo García-Olivares, Jose Eugenio Guerrero (Gregorio Marañón Universitary Hospital, Madrid), Pedro Galdos (Puerta de Hierro Universitary Hospital, Madrid), Demetrio Carriedo (León Universitary Hospital, León), Francisco Murillo (Virgen del Rocio Universitary Hospital, Seville), Antonio Rivera (San Agustin Hospital, Asturias).

PROF-ETEV investigators:

Enrique Pino (H Rio Tinto, Huelva), María Victoria Torres (H Virgen de la Victoria, Málaga), Azucena de la Campa (HU Valme, Sevilla), Francisco José Romero (H Jerez ASISA, Cádiz), Luis Jiménez (H Santa Isabel, Sevilla), Manuel Castellano (H Alto Guadalquivir, Jaen), Jose Luis García (H San Juan de Dios, Sevilla), Luisa Cantón (H Virgen de la Macarena, Sevilla), Rebeca Olalla (H Parque San Antonio, Málaga), Ana María de la Torre (H Xanit Internacional, Málaga), Guillermo Quesada (HU Carlos Haya, Málaga), Fernando Barra (HU Miguel Servet, Zaragoza), Raquel Bustamante y Belén Jiménez (HU Lozano Blesa, Zaragoza), Eduardo Antón (H Manacor, Menorca), Jose Ignacio Ayestarán (HU Son Espases, Mallorca), María Ripoll (HG Fuerteventura, Las Palmas), Moises Sánchez (H Doctor Jose Molina Orosa, Lanzarote), Ana Bueno (HU Ciudad Real), Elena Yañez (HU Guadalajara), Victoria Merino (H Virgen de la Salud, Toledo), Jose Manuel Gutierrez (HU Albacete), Miriam Riesco y Miriam González (CAU León), Virginia Fraile (HU Rio Hortega, Valladolid), Mercedes Martín-Macho (CA Palencia), Sergio Ossa (HU Burgos), Antonia Vazquez (H del Mar-Parq de Salut Mar, Barcelona), Juan Carlos Ruiz (H Vall d´Hebron, Barcelona), Juan Carlos Villalba e Hipólito Pérez (H Germans Trias I Pujol, Barcelona), Rosa María Catalán (HG de Vic, Barcelona), Basilio Sánchez, Elena Gallego y Rocio Manzano (H San Pedro de Alcántara, Cáceres), Loro Vieites (H Infanta Cristina, Badajoz), Marcela Peruccioni y Juan Bonastre (HU la Fe, Valencia), Laura Galarza (HU Castellón), Laura Beliver (HU Doctor Peset, Valencia), Pablo Vidal (HU Ourense), David Mosquera (H Meixoeiro, Vigo), Eva Menor (HU Vigo), Jose Francisco Olea (H Lucus Augusti, Lugo), Rita Galeiras y Leticia Seoane (HU A Coruña), Jose Luis Monzón (H San Pedro, Logroño), Ana María Hernangómez, Dennis O Stanescu y Ana Lajara (HU Gregorio Marañón, Madrid), Amparo Carbonell, Susana Temprano y Emilio Alted (HU Doce de Octubre, Madrid), Ana Villasclaras y Susana García (HU Ramón y Cajal, Madrid), Miguel Angel González y Alberto Valverde (HU Clínico San Carlos, Madrid), Federico Gordo (HU del Henares, Madrid), Nicolas Nin (HU de Torrejón), Cesar Pérez (Fundación Jiménez Díaz, Madrid), Teresa Honrubia (HU Mostoles, Madrid), Santiago Yuste y Juan Carlos Figueira (HU La Paz), Alberto Rubio (HM Montepríncipe, Madrid), Joaquín Alvarez (HU Fuenlabrada, Madrid), Pedro Galdos (HU Puerta de Hierro, Madrid), María Isabel Moreno (H Infanta Cristina, Madrid), Ana de Pablo (HU Sureste, Madrid), Eduardo Palencia (HU Infanta Leonor, Madrid), Luis Córdoba (HM Sanchinarro, Madrid), Judit Iglesias (HU La Princesa, Madrid), Santiago Jose Villanueva y Francisco Leon (HC de Melilla), Jose Manuel Allegue y Luis Herrera (HU Santa Lucia, Murcia), Andrés Carrillo (HU Jose María Morales Meseguer, Murcia), Isabel Cremades (HU Reina Sofia, Murcia), Jose Raúl Arevalo (HU Cruces, Bilbao), Mercedes Zabarte (HU Donostia, San Sebastian), María Martínez y Belén García (HUC de Asturias, Oviedo), Gerardo Aguilar, Juan Vicente Llau, Gergana Gencheva y Francisco Javier Belda (HCU De Valencia).

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García-Olivares, P., Guerrero, J.E., Galdos, P. et al. PROF-ETEV study: prophylaxis of venous thromboembolic disease in critical care units in Spain. Intensive Care Med 40, 1698–1708 (2014). https://doi.org/10.1007/s00134-014-3442-1

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Keywords

  • Venous thromboembolic disease
  • Critically ill patients
  • Antithrombotic therapy
  • Critical care unit