Thromboembolic risk factors and thromboprophylaxis in a medical–surgical ICU in Mexico

Introduction

Venous thromboembolic disease (VTD) is an important cause of morbimortality of critically ill patients, whom frequently have several VTD risk factors but lack the appropriate preventive measures. We conducted a study to identify the VTD risk factors, prevalence and use of prophylaxis in our ICU.

Methods

We conducted a prospective, observational study of all patients admitted to the adult ICU of our hospital in a 4-month period. We documented epidemiological data, VTD risk factors, and use of thromboprophylaxis. We used a risk scale that stratified patients in one of four levels of thromboembolic risk (low, intermediate, high, and very high) according to the number of VTD risk factors present. Daily clinical screenings for pulmonary or peripheral venous thromboembolism (VTE) were performed. Patients were contacted 30 days after discharge from the ICU to assess for any post-ICU VTE events.

Results

Two hundred and eighteen consecutive patients were included (134 males) with an average age of 61 ± 18.6 years. The average length of stay at the ICU was 5.7 ± 12.9 days. The most frequent risk factors were age >60 years (83%), obesity (41%), smoking (33%), recent major surgical procedure (30%), and diabetes (22%). A total of 51.4% (112/218) of the patients had five or more VTD risk factors (very-high-risk category), while 34% (74/218) had three to four VTD risk factors (high-risk category). Less than 50% of the patients received any thromboprophylaxis. Most of those that had VTD prophylaxis used mechanical devices (96/218; 44%), followed by low molecular weight heparins such as enoxaparin (82/218; 38%). Twelve patients developed an identifiable thrombotic event: six male patients developed VTE while in the ICU; two of them developed massive pulmonary embolism and died. On follow-up assessment we contacted 183 patients and identified six that developed clinical data of a new, nonsevere VTE event after ICU discharge. All 12 patients who developed VTE had five or more VTD risk factors, locating them in the very-high-risk category.

Conclusion

Most of the patients admitted to our ICU had several risk factors that predisposed them to VTE events. In spite of that, less than one-half of our patients received VTD prophylaxis. VTE developed only in patients who had five or more risk factors. We suggest performing regular VTE assessments in this group of patients.