Lauzier, F., Muscedere, J., Deland, É., Kutsogiannis, D. J., Jacka, M., Heels-Ansdell, D., Crowther, M., Cartin-Ceba, R., Cox, M. J., Zytaruk, N., Foster, D., Sinuff, T., Clarke, F., Thompson, P., Hanna, S., Cook, D., Hall, R., Julien, L., St. Laurent, M., ... Grainger, L. (2014). Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit. Critical Care, 18(2), Article R82. https://doi.org/10.1186/cc13844
Lauzier, F, Muscedere, J, Deland, É, Kutsogiannis, DJ, Jacka, M, Heels-Ansdell, D, Crowther, M, Cartin-Ceba, R, Cox, MJ, Zytaruk, N, Foster, D, Sinuff, T, Clarke, F, Thompson, P, Hanna, S, Cook, D, Hall, R, Julien, L, St. Laurent, M, Meade, M, Hand, L, Laberge, A, McIntyre, L, Pagliarello, G, Watpool, I, McArdle, T, Van Tol, A, Zito, N, Van Beinum, A, Castellucci, LA, Reddie, S, Skrobik, Y, Harvey, J, Beauregard, B, Albert, M, Williamson, D, Coralie, G, Mehta, S, Brown, M, Kuint, R, Fowler, R, Marinoff, N, Raghunath, A, Rousseau, A, Marshall, J, Smith, O, Lee, Y, Wang, M, Roy, P, Faraj, R, Fleury, S, Godfrey, N, Griesdale, D, Logie, S, Martinka, G, Dodek, P, Ashley, BJ, Anis, S, Brewer, K, Shepherd, S, Lellouche, F, Ferland, MC, Karachi, T, Irwin, M, Hannigan, S, Gentles, E, Wood, G, Auld, F, Atkins, L, Lamontagne, F, Parent, M, Langevin, C, Paunovic, B, Marten, N, Eggerton, S, Jossy, D, Bush, S, Kumar, H, Shea, P, Roussos, M, Stoger, S, Cryderman, C, Romano, K, Carli, A, Hicklin, D, Meade, L, Wilson, G, Krpata, T, Marquez, A, O'Brien, J, Krause, C, Cyton, M, Fowler, K, Hubert, C, Barlow Cash, C, Krolicki, K & Grainger, L 2014, 'Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit', Critical Care, vol. 18, no. 2, R82. https://doi.org/10.1186/cc13844
@article{71e4bfd047554b0087e38768c76bc36f,
title = "Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit",
abstract = "Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.",
author = "Fran{\c c}ois Lauzier and John Muscedere and {\'E}ric Deland and Kutsogiannis, {Demetrios J.} and Michael Jacka and Diane Heels-Ansdell and Mark Crowther and Rodrigo Cartin-Ceba and Cox, {Michael J.} and Nicole Zytaruk and Denise Foster and Tasnim Sinuff and France Clarke and Patrica Thompson and Steven Hanna and Deborah Cook and Rick Hall and Lisa Julien and {St. Laurent}, Michelle and Maureen Meade and Lori Hand and Ann Laberge and Lauralyn McIntyre and Guiseppe Pagliarello and Irene Watpool and Tracy McArdle and {Van Tol}, Allyshia and Nicole Zito and {Van Beinum}, Amanda and Castellucci, {Lana Antoinette} and Shawna Reddie and Yoanna Skrobik and Johanne Harvey and Brigitte Beauregard and Martin Albert and David Williamson and Guilaine Coralie and Sangeeta Mehta and Maedean Brown and Rottem Kuint and Robert Fowler and Nicole Marinoff and Ashwati Raghunath and Alexandra Rousseau and John Marshall and Orla Smith and Yoon Lee and Melissa Wang and Pragma Roy and Raphael Faraj and Susan Fleury and Nicole Godfrey and Donald Griesdale and Susan Logie and Greg Martinka and Peter Dodek and Ashley, {Betty Jean} and Sabrina Anis and Kelsey Brewer and Sarah Shepherd and Francois Lellouche and Ferland, {Marie Claude} and Tim Karachi and Marleen Irwin and Shanice Hannigan and Emily Gentles and Gordon Wood and Fiona Auld and Leslie Atkins and Fran{\c c}ois Lamontagne and Marylise Parent and Chantal Langevin and Bojan Paunovic and Nicole Marten and Shauna Eggerton and Darlene Jossy and Samara Bush and Hari Kumar and Patricia Shea and Marios Roussos and Sandra Stoger and Cindy Cryderman and Kathleen Romano and Amanda Carli and Deanna Hicklin and Laurie Meade and Gregory Wilson and Tami Krpata and Alberto Marquez and Jackie O'Brien and Catherine Krause and Margaret Cyton and Kimberly Fowler and Catherine Hubert and {Barlow Cash}, Ceilidh and Katherine Krolicki and Laurel Grainger",
note = "Funding Information: This study was funded by the Hamilton Academy of Health Sciences. FL is a recipient of a Research Career Award from the Fonds de la recherche du Qu{\'e}bec-Sant{\'e}. DC holds a Chair of the Canadian Institutes of Health Research. The authors are grateful for the support of the Canadian Critical Care Trials Group. They are grateful to Dr H Stelfox and Dr C Martin for their suggestions on earlier drafts of this manuscript. The authors sincerely thank the Research Coordinators and Investigators who participated in this study (listed below). Funding Information: MC sat on advisory boards for Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, and Artisan Pharma; prepared educational materials for Pfizer, Octapharm, and CSL Behring; and provided expert testimony for Bayer. MC{\textquoteright}s institution has received funding for research projects from Boehringer Ingelheim, Octapharm, Pfizer, and Leo Pharma. DC received peer review funding from CIHR for the randomized trial PROTECT comparing unfractionated heparin versus the low molecular weight dalteparin. Pfizer and Eisai Inc. donated dalteparin. NZ and DH-A received conference support from Pfizer. The remaining authors declare that they have no competing interests.",
year = "2014",
month = apr,
day = "25",
doi = "10.1186/cc13844",
language = "English",
volume = "18",
journal = "Critical Care",
issn = "1364-8535",
publisher = "Springer Science + Business Media",
number = "2",
}
TY - JOUR
T1 - Thromboprophylaxis patterns and determinants in critically ill patients
T2 - A multicenter audit
AU - Lauzier, François
AU - Muscedere, John
AU - Deland, Éric
AU - Kutsogiannis, Demetrios J.
AU - Jacka, Michael
AU - Heels-Ansdell, Diane
AU - Crowther, Mark
AU - Cartin-Ceba, Rodrigo
AU - Cox, Michael J.
AU - Zytaruk, Nicole
AU - Foster, Denise
AU - Sinuff, Tasnim
AU - Clarke, France
AU - Thompson, Patrica
AU - Hanna, Steven
AU - Cook, Deborah
AU - Hall, Rick
AU - Julien, Lisa
AU - St. Laurent, Michelle
AU - Meade, Maureen
AU - Hand, Lori
AU - Laberge, Ann
AU - McIntyre, Lauralyn
AU - Pagliarello, Guiseppe
AU - Watpool, Irene
AU - McArdle, Tracy
AU - Van Tol, Allyshia
AU - Zito, Nicole
AU - Van Beinum, Amanda
AU - Castellucci, Lana Antoinette
AU - Reddie, Shawna
AU - Skrobik, Yoanna
AU - Harvey, Johanne
AU - Beauregard, Brigitte
AU - Albert, Martin
AU - Williamson, David
AU - Coralie, Guilaine
AU - Mehta, Sangeeta
AU - Brown, Maedean
AU - Kuint, Rottem
AU - Fowler, Robert
AU - Marinoff, Nicole
AU - Raghunath, Ashwati
AU - Rousseau, Alexandra
AU - Marshall, John
AU - Smith, Orla
AU - Lee, Yoon
AU - Wang, Melissa
AU - Roy, Pragma
AU - Faraj, Raphael
AU - Fleury, Susan
AU - Godfrey, Nicole
AU - Griesdale, Donald
AU - Logie, Susan
AU - Martinka, Greg
AU - Dodek, Peter
AU - Ashley, Betty Jean
AU - Anis, Sabrina
AU - Brewer, Kelsey
AU - Shepherd, Sarah
AU - Lellouche, Francois
AU - Ferland, Marie Claude
AU - Karachi, Tim
AU - Irwin, Marleen
AU - Hannigan, Shanice
AU - Gentles, Emily
AU - Wood, Gordon
AU - Auld, Fiona
AU - Atkins, Leslie
AU - Lamontagne, François
AU - Parent, Marylise
AU - Langevin, Chantal
AU - Paunovic, Bojan
AU - Marten, Nicole
AU - Eggerton, Shauna
AU - Jossy, Darlene
AU - Bush, Samara
AU - Kumar, Hari
AU - Shea, Patricia
AU - Roussos, Marios
AU - Stoger, Sandra
AU - Cryderman, Cindy
AU - Romano, Kathleen
AU - Carli, Amanda
AU - Hicklin, Deanna
AU - Meade, Laurie
AU - Wilson, Gregory
AU - Krpata, Tami
AU - Marquez, Alberto
AU - O'Brien, Jackie
AU - Krause, Catherine
AU - Cyton, Margaret
AU - Fowler, Kimberly
AU - Hubert, Catherine
AU - Barlow Cash, Ceilidh
AU - Krolicki, Katherine
AU - Grainger, Laurel
N1 - Funding Information:
This study was funded by the Hamilton Academy of Health Sciences. FL is a recipient of a Research Career Award from the Fonds de la recherche du Québec-Santé. DC holds a Chair of the Canadian Institutes of Health Research. The authors are grateful for the support of the Canadian Critical Care Trials Group. They are grateful to Dr H Stelfox and Dr C Martin for their suggestions on earlier drafts of this manuscript. The authors sincerely thank the Research Coordinators and Investigators who participated in this study (listed below).
Funding Information:
MC sat on advisory boards for Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, and Artisan Pharma; prepared educational materials for Pfizer, Octapharm, and CSL Behring; and provided expert testimony for Bayer. MC’s institution has received funding for research projects from Boehringer Ingelheim, Octapharm, Pfizer, and Leo Pharma. DC received peer review funding from CIHR for the randomized trial PROTECT comparing unfractionated heparin versus the low molecular weight dalteparin. Pfizer and Eisai Inc. donated dalteparin. NZ and DH-A received conference support from Pfizer. The remaining authors declare that they have no competing interests.
PY - 2014/4/25
Y1 - 2014/4/25
N2 - Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.
AB - Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.
UR - http://www.scopus.com/inward/record.url?scp=84901593223&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901593223&partnerID=8YFLogxK
U2 - 10.1186/cc13844
DO - 10.1186/cc13844
M3 - Article
C2 - 24766968
AN - SCOPUS:84901593223
SN - 1364-8535
VL - 18
JO - Critical Care
JF - Critical Care
IS - 2
M1 - R82
ER -
