Modern thromboprophylaxis protocol based on guidelines applied in a respiratory intensive care unit: a single-center prospective cohort study

Abstract

Background Critically ill patients in intensive care units (ICUs) are at high risk of venous thromboembolism (VTE). This study aimed to explore the prophylaxis effect under a guideline-based thromboprophylaxis protocol among critically ill patients in a respiratory ICU. Methods For this single-center prospective cohort study, we followed the thromboprophylaxis protocol, which was drawn up based on relevant guidelines and Chinese experts’ advice. Clinical data were entered into an electronic case report form and analyzed. Multivariate logistic regression was conducted to explore independent risk factors of VTE event under this protocol. Results From August 1, 2014, to December 31, 2020, 884 patients underwent thromboprophylaxis according to this protocol; 10.5% of them received mechanical prophylaxis, 43.8% received pharmacological prophylaxis, and 45.7% received pharmacological combined with mechanical prophylaxis. The proportion of VTE events was 14.3% for patients who received the thromboprophylaxis protocol, of which 0.1% had pulmonary thromboembolism (PTE), 2.0% had proximal deep vein thrombosis (DVT), and 12.1% had isolated distal DVT. There was no significant difference between different thromboprophylaxis measures. Cirrhosis (OR 5.789, 95% CI [1.402, 23.894], P = 0.015), acute asthma exacerbation (OR 39.999, 95% CI [4.704, 340.083], P = 0.001), and extracorporeal membrane oxygenation treatment (OR 22.237, 95%CI [4.824, 102.502], P < 0.001) were independent risk factors for proximal DVT under thromboprophylaxis. Conclusions The thromboprophylaxis protocol based on guidelines applied in the ICU was practicable and could help decrease the proportion of PTE and proximal DVT events. The risk factors of VTE events happening under the thromboprophylaxis protocol require more attention. Trial registration ClinicalTrials.gov: NCT02213978.

Risk factors and a nomogram model for deep vein thrombosis in critically ill patients with sepsis: a retrospective analysis

“…Current guidelines also recommend the use of anticoagulant prophylaxis in all critically ill patients at high risk of DVT, rather than mechanical prophylaxis [14,15]. However, despite the appropriate use of pharmacologic thromboprophylaxis, critically ill patients still demonstrated high rates of DVT, which vary from 7.8-37.5% [3,[17][18][19][20][21]. In our study, the proportion of patients receiving pharmacologic thromboprophylaxis in the DVT group was greater than that in the group without DVT, while the subgroup analysis showed no statistical difference in anticoagulant duration or dose between the two groups.…”

The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study

“…[16] Additionally, the risk of VTE is elevated in intensive care unit (ICU) patients. [17][18][19] Exploring the risk factors and effective preventive measures for VTE in the ICU setting may contribute to better rehabilitation outcomes for these patients. [20,21] Furthermore, men are more susceptible to VTE compared to women, [22] and estrogen therapy has been shown to reduce the risk of VTE.…”

Effectiveness and safety of rivaroxaban for anticoagulation therapy in COVID-19

“…Anticoagulants are widely used to prevent and treat thromboembolic and coagulation disorders, but the role and benefits of anticoagulants in patients with COVID-19 remain uncertain according to current clinical trials and meta-analyses. 7 - 9 Although prophylactic anticoagulation is recommended for hospitalized COVID-19 patients based on expert consensus and opinion, the current quality of evidence remains poor. 10 , 11 For anticoagulation in these patients, the recommended option is mainly low-molecular-weight heparins (LMWHs).…”