Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients* - PubMed (original) (raw)

Randomized Controlled Trial

doi: 10.1097/CCM.0000000000000713.

Maureen Meade, Francois Lauzier, Ryan Zarychanski, Sangeeta Mehta, Francois Lamontagne, Peter Dodek, Lauralyn McIntyre, Richard Hall, Diane Heels-Ansdell, Robert Fowler, Menaka Pai, Gordon Guyatt, Mark A Crowther, Theodore E Warkentin, P J Devereaux, Stephen D Walter, John Muscedere, Margaret Herridge, Alexis F Turgeon, William Geerts, Simon Finfer, Michael Jacka, Otavio Berwanger, Marlies Ostermann, Ismael Qushmaq, Jan O Friedrich, Deborah J Cook; PROphylaxis for ThromboEmbolism in Critical Care Trial Investigators

Collaborators, Affiliations

Randomized Controlled Trial

Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients*

Wendy Lim et al. Crit Care Med. 2015 Feb.

Abstract

Objectives: To identify risk factors for failure of anticoagulant thromboprophylaxis in critically ill patients in the ICU.

Design: Multivariable regression analysis of thrombosis predictors from a randomized thromboprophylaxis trial.

Setting: Sixty-seven medical-surgical ICUs in six countries.

Patients: Three thousand seven hundred forty-six medical-surgical critically ill patients.

Interventions: All patients received anticoagulant thromboprophylaxis with low-molecular-weight heparin or unfractionated heparin at standard doses.

Measurements and main results: Independent predictors for venous thromboembolism, proximal leg deep vein thrombosis, and pulmonary embolism developing during critical illness were assessed. A total of 289 patients (7.7%) developed venous thromboembolism. Predictors of thromboprophylaxis failure as measured by development of venous thromboembolism included a personal or family history of venous thromboembolism (hazard ratio, 1.64; 95% CI, 1.03-2.59; p = 0.04) and body mass index (hazard ratio, 1.18 per 10-point increase; 95% CI, 1.04-1.35; p = 0.01). Increasing body mass index was also a predictor for developing proximal leg deep vein thrombosis (hazard ratio, 1.25; 95% CI, 1.06-1.46; p = 0.007), which occurred in 182 patients (4.9%). Pulmonary embolism occurred in 47 patients (1.3%) and was associated with body mass index (hazard ratio, 1.37; 95% CI, 1.02-1.83; p = 0.035) and vasopressor use (hazard ratio, 1.84; 95% CI, 1.01-3.35; p = 0.046). Low-molecular-weight heparin (in comparison to unfractionated heparin) thromboprophylaxis lowered pulmonary embolism risk (hazard ratio, 0.51; 95% CI, 0.27-0.95; p = 0.034) while statin use in the preceding week lowered the risk of proximal leg deep vein thrombosis (hazard ratio, 0.46; 95% CI, 0.27-0.77; p = 0.004).

Conclusions: Failure of standard thromboprophylaxis using low-molecular-weight heparin or unfractionated heparin is more likely in ICU patients with elevated body mass index, those with a personal or family history of venous thromboembolism, and those receiving vasopressors. Alternate management or incremental risk reduction strategies may be needed in such patients.

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