Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients

Abstract

Background. Thromboembolic events are major causes of morbidity, and prevention is important. We aimed to compare chemical prophylaxis (CP) and mechanical prophylaxis (MP) as methods of prevention in nonsurgical patients on mechanical ventilation. Methods. We performed a retrospective study of adult patients admitted to the Cooper University Hospital ICU between 2002 and 2010. Patients on one modality of prophylaxis throughout their stay were included. The CP group comprised 329 patients and the MP group 419 patients. The primary outcome was incidence of thromboembolic events. Results. Acuity measured by APACHE II score was comparable between the two groups (p = 0.215). Univariate analysis showed 1 DVT/no PEs in the CP group and 12 DVTs/1 PE in the MP group (p = 0.005). Overall mortality was 34.3% and 50.6%, respectively. ICU LOS was similar. Hospital LOS was shorter in the MP group. Multivariate analysis showed a significantly higher incidence of events in the MP prophylaxis group (odds ratio 9.9). After excluding patients admitted for bleeding in both groups, repeat analysis showed again increased events in the MP group (odds ratio 2.9) but this result did not reach statistical significance. Conclusion. Chemical methods for DVT/PE prophylaxis seem superior to mechanical prophylaxis in nonsurgical patients on mechanical ventilation and should be used when possible.

Deep Vein Thrombosis Prophylaxis Evaluation in Intensive Care Unit

“…Mechanical prophylaxis consists of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) devices used for patients at low risk. Subcutaneous unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are common pharmacological prophylaxis regimens that are usually prescribed (9).…”

A survey of knowledge and application of mechanical thromboprophylaxis among the medical staff of intensive care units in North China

“…Once the hemorrhage stops or the bleeding risk is decreased, pharmacological thromboprophylaxis should be substituted for mechanical thromboprophylaxis if the VTE risk persists. Research from Gaspard et al showed that chemical VTE prophylaxis methods seemed to be superior to mechanical prophylaxis in nonsurgical patients on mechanical ventilation . Based on the current evidence, mechanical thromboprophylaxis should not replace pharmacological thromboprophylaxis.…”

Preventing Venous Thromboembolism in Adults

“…Mechanical methods of prophylaxis (GCSs, IPCDs, and venous foot pumps [VFPs]) reduce the risk of VTE. [22][23][24][25][26][27][28][29][30][31][32] Mechanical prophylaxis methods are a desirable option because they do not pose bleeding concerns. 6 A meta-analysis was done to evaluate the effectiveness of GCSs for prevention of DVT in hospitalized medicalsurgical patients, and the researchers concluded that GCSs decreased the incidence of DVT, particularly in general and orthopedic surgery patients.…”

“…Evidence comparing mechanical prophylaxis with pharmacological prophylaxis for VTE prevention in critically ill patients is limited. 24 In an observational study, researchers reported that critically ill patients receiving pharmacological prophylaxis had a lower risk of death than did patients www.ccnonline.org receiving mechanical prophylaxis. 3 A combination of mechanical prophylaxis and pharmacological prophylaxis is thought to potentiate the overall efficacy of VTE prevention.…”

“…25 Results of recent RCTs in critically ill patients also suggest that combination therapy is superior to either pharmacological or mechanical prophylaxis alone. 24,29 Interprofessional Assessment 1. Written guidelines, 35 continuing education, 36 daily rounds checklists, 37 and electronic alerts 38 for VTE prophylaxis increase compliance with prophylaxis measures.…”