Supportive and Preventive Medicine

critically ill population is challenging because of inconsistencies in patient populations, different

diagnosis strategies, and variable study methodologies.

In the absence of prophylaxis: 30% in medical-surgical patients, 50%–60% in trauma patients, up

to 80% in orthopedic surgical patients, and 20%–50% in neurosurgical patients (Arch Intern Med

2001;161:1268-79)

A randomized controlled trial of medical-surgical ICU patients receiving pharmacologic prophylaxis

found proximal DVT rates of 5%–6% using ultrasonography twice weekly for detection (N Engl J

Med 2011;364:1305-14).

Malignancy, previous VTE, immobility, known thrombophilia, recent (1 month or less) surgery or

trauma, older age (70 or older), heart or respiratory failure, sepsis, obesity (body mass index of 30

kg/m2 or more), pregnancy, erythropoiesis-stimulating agents with a hemoglobin of 12 g/dL or more,

hormonal therapy, recent transfusions of concentrated clotting factors, central venous lines, and long-

distance travel (Chest 2012;141:S195-226)

identified four independent risk factors for ICU-acquired VTE: personal or family history of VTE

(multivariate hazard ratio [HR] 4.0; 95% CI, 1.5–10.3; p=0.004), end-stage renal failure (HR 3.7; 95%

CI, 1.2–11.1; p=0.02), platelet transfusion (HR 3.2; 95% CI, 1.2–8.4; p=0.02), and vasopressor use (HR

In the critically ill population, there are no validated risk assessment models to estimate the risk of

VTE.

Routine ultrasound screening is not recommended (Chest 2012;141:S195-226).

Mechanical VTE prophylaxis should be used in a critically ill patient if the patient is bleeding or at

high risk of bleeding. Once the bleeding risk abates, pharmacologic VTE prophylaxis can be initiated.

Intermittent pneumatic compression devices and graduated compression stockings (GCS)

significantly reduce the risk of symptomatic VTE compared with no prophylaxis (Chest

2012;141:S195-226).

A Cochrane review evaluated the results from 19 studies of GCS (Cochrane Database Syst Rev

2014;12:1-72).

DVT rates were 9% in the GCS group and 21% in the control group (OR 0.33; p<0.00001), and

pulmonary embolism rates were 2% in the GCS group and 5% in the control group (OR 0.38;

p=0.04).

ii.

The patient population was largely limited to those undergoing orthopedic and general surgery.

Data are limited in medical critically ill patients.