Venous Thromboembolism in the Intensive Care Unit

  • Lisa M. Kodadek
  • Elliott R. HautEmail author


Venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE), or both, is common among critically ill surgical patients and potentially preventable in many cases. Despite high-quality evidence-based guidelines for VTE prophylaxis, many patients do not receive risk-appropriate prophylaxis, and over 100,000 people continue to die from VTE in the United States (US) each year. Critical care patients are at even higher risk for VTE than other hospitalized patients secondary to additional risk factors including vasopressor use, mechanical ventilation, pharmacologic sedation, immobilization, surgery, and central venous catheters. Furthermore, VTE is often clinically silent among critical care patients and timely diagnosis may be challenging. Duplex ultrasonography and contrast-enhanced computed tomography (CT) angiography are the best modalities for diagnosis of DVT and PE, respectively. Severity of PE may be evaluated with transthoracic or transesophageal echocardiography. The mainstay of treatment for DVT and PE is systemic anticoagulation, although patients with PE and associated hemodynamic instability or cardiac failure may require more invasive treatment interventions. Management of VTE in the intensive care unit (ICU) is complicated because many patients have high risk of bleeding from concomitant major surgery, trauma, coagulopathy, or gastrointestinal bleeding. All ICU patients require risk-appropriate VTE prophylaxis because all ICU patients are at risk for VTE. The majority of patients should receive pharmacologic prophylaxis, although some will have a contraindication and should receive mechanical sequential compression devices instead. It is important to recognize risk factors, prescribe and administer effective prophylaxis, and provide timely diagnosis and treatment for patients with VTE in the ICU.


Deep vein thrombosis Intensive care unit Pulmonary embolism Surgical critical care Venous thromboembolism Venous thromboembolism prophylaxis 

Abbreviations and Acronyms


The American Academy of Orthopaedic Surgeons


The American College of Chest Physicians


The Agency for Healthcare Research and Quality


Computed tomography


Deep vein thrombosis


The Eastern Association for the Surgery of Trauma


Extracorporeal membrane oxygenation


Intensive care unit


International normalized ratio


Inferior vena cava


Low molecular weight heparin


Pulmonary embolism




Sequential compression devices


Thromboembolic deterrent stockings


United States

V/Q scan

Ventilation/perfusion scan


Venous thromboembolism


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Authors and Affiliations

  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of Acute Care Surgery, Department of Surgery, Anesthesiology/Critical Care Medicine, and Emergency MedicineJohns Hopkins University School of Medicine, Health Policy and Management, Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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