Implementation of evidence in clinical practice for prevention of thromboembolic events in intensive medicine

Objective

To determine the association between the high risk to embolic events and the application of guidelines for their prevention in ICU patients.

Methods

A retrospective study evaluating the medical files of 200 ICU patients. Inclusion criteria: patients ≥18 years old that did not have diagnosis of deep-vein thromboembolism (DVP) and pulmonary embolism (PE) at internment. Exclusion criteria: use of previous or present anticoagulant, counterindication for use of heparin in prophylactic doses. The patients were classified according to risk stratification to thromboembolism of low, moderate and high risk.

Results

One hundred and seven patients were included. The most prevalent risk factors to PE were: age over 40 years old (72.0%), longer than 3 days in bed (49.5%), longer than 60 minutes of surgery (43.0%), central venous catheterization (32.7%) and cancer (21.5%). The risk stratification showed 15.9% low-risk patients, 63.6% moderate-risk patients and 20.6% high-risk patients. The performance of any type of prophylaxis (physical or pharmacological) was 64.8% (80 patients). Out of these 80 patients, 30 patients (37.5%) received physical prophylaxis (26.7% precautious walking, 46.7% inferior limb elevation and 93.3% physiotherapy) and 75 patients (93.8%) received pharmacological prophylaxis (37.3% unfractionated heparin, 64% heparin with low molecular weight). The association between high risk and prophylaxis was not significant (P = 0.269, Fisher's test).

Conclusion

This study showed a nonsignificant association (P = 0.269) between high risk for thromboembolism and the performance of thromboprophylaxis, which is a potential risk factor for mortality in the ICU.