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Venous Thromboembolism in Coagulopathic Surgical Intensive Care Unit Patients: Is There a Benefit From Chemical Prophylaxis?

Edwards, Meghan MD; Felder, Seth MD; Ley, Eric MD; Srour, Marissa BS; Mirocha, James MS; Margulies, Daniel R. MD; Salim, Ali MD

Journal of Trauma-Injury Infection & Critical Care: June 2011 - Volume 70 - Issue 6 - pp 1398-1400
doi: 10.1097/TA.0b013e318217868d
Original Article

Background: Coagulation abnormalities in critically ill surgical patients cause confusion in administration of venous thromboembolism (VTE) prophylaxis. Pharmaceutical VTE prophylaxis is often withheld because of presumed increased risk for bleeding and assumption that these patients would not benefit from it. Coagulopathic critically ill surgical patients are at risk for VTE and should be treated with chemical prophylaxis.

Methods: A retrospective review was performed of all coagulopathic patients (international normalized ration >1.5 or platelets <100,000 per μL) admitted for at least 72 hours to the surgical intensive care units of a tertiary care center between January 2008 and January 2009. Patients were divided into two groups based on providing (group 1) or withholding (group 2) chemical prophylaxis. The incidence of VTE was then compared between the two groups.

Results: A total of 513 patients were included in the study: 241 patients in group 1 and 272 patients in group 2. The overall incidence of VTE was 16.4%. The incidence of VTE in the patients who received chemical prophylaxis was 17.0%, whereas the incidence in patients without chemical prophylaxis was 15.8% (p = 0.72).

Conclusion: Coagulopathic critically ill surgical patients remain at significant risk for VTE. Unfortunately, chemical VTE prophylaxis does not seem to decrease this risk. Further research is warranted to investigate the nature of this increased risk of VTE and the reason chemical VTE prophylaxis has no benefit.

From the Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

Submitted for publication December 1, 2010.

Accepted for publication February 25, 2011.

Presented as a poster at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Address for reprints: Ali Salim, MD, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA 90048; email: ali.salim@cshs.org.

© 2011 Lippincott Williams & Wilkins, Inc.