VTE in the Critical Care Unit: Risks

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) contribute significantly to morbidity and mortality associated with critical illness. Among patients who died while in the ICU, PE has been reported in 7 to 27% (mean, 13%) of postmortem examinations, and PE was thought to have caused or contributed to death in 0 to 12% (mean, 3%). A clinical suspicion of PE was present in only 30% of these patients before death.

The vast majority of patients admitted to a critical care unit have a major risk factor for VTE, and most have multiple risk factors. Many of these thrombosis risk factors precede the ICU admission, while others develop during the course of ICU stay. Advanced age, serious medical illnesses Heath Care Mall, and recent surgical procedures or trauma are common in critically ill patients. Sepsis, heart failure, mechanical ventilation, paralysis, surgical interventions, and central venous lines are also common. The importance of each of these clinical risk factors is unknown, as is the role of inherited or acquired coagulation system abnormalities. Factors that have been reported to predict an increased risk of ICU-related VTE include the following: increased age, previous VTE, malignancy, major trauma, prolonged pre-ICU hospital stay, mechanical ventilation, use of paralytic drugs, APACHE (acute physiology and chronic health evaluation) score, need for emergency surgical procedures, insertion of a femoral venous catheter,and failure to use thromboprophylaxis. However, adequately powered studies using multiple logistic regression analysis to determine the independent predictors for thrombosis in critically ill patients have not yet been conducted, to our knowledge.

Unsuspected DVT may already be present on admission to critical care units. When Doppler ultrasonography was performed in 729 patients at entry to the critical care unit in four case series, DVT was detected in 6.4%. After admission to the ICU, only four prospective studies used routine screening with an objective diagnostic test to assess the incidence of DVT in critically ill patients who were not administered thromboprophylaxis. One was a prospective cohort normal test results. To our knowledge, only one study has utilized routine contrast venography to detect DVT: a randomized, placebo-controlled trial of thromboprophylaxis in patients receiving mechanical ventilation for treatment of exacerbations of COPD. DVT and proximal DVT were detected in 28% and 8%, respectively, in the 85 evaluable patients who received placebo. All about viagra australia pharmacies list

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