TY - JOUR
T1 - Failure of anticoagulant thromboprophylaxis
T2 - Risk factors in medical-surgical critically Ill patients
AU - Lim, Wendy
AU - Meade, Maureen
AU - Lauzier, Francois
AU - Zarychanski, Ryan
AU - Mehta, Sangeeta
AU - Lamontagne, Francois
AU - Dodek, Peter
AU - McIntyre, Lauralyn
AU - Hall, Richard
AU - Heels-Ansdell, Diane
AU - Fowler, Robert
AU - Pai, Menaka
AU - Guyatt, Gordon
AU - Crowther, Mark A.
AU - Warkentin, Theodore E.
AU - Devereaux, P. J.
AU - Walter, Stephen D.
AU - Muscedere, John
AU - Herridge, Margaret
AU - Turgeon, Alexis F.
AU - Geerts, William
AU - Finfer, Simon
AU - Jacka, Michael
AU - Berwanger, Otavio
AU - Ostermann, Marlies
AU - Qushmaq, Ismael
AU - Friedrich, Jan O.
AU - Cook, Deborah J.
N1 - Publisher Copyright:
Copyright © 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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 lowmolecular- 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. (Crit Care Med 2015; 43:401-410).
AB - 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 lowmolecular- 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. (Crit Care Med 2015; 43:401-410).
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U2 - 10.1097/CCM.0000000000000713
DO - 10.1097/CCM.0000000000000713
M3 - Article
C2 - 25474533
AN - SCOPUS:84925351608
SN - 0090-3493
VL - 43
SP - 401
EP - 410
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 2
ER -