Heparin Thromboprophylaxis in Medical-Surgical Critically Ill Patients

Alhazzani, Waleed; Lim, Wendy; Jaeschke, Roman; Murad, M. Hassan; Cade, J. F. J.; Cook, Deborah J.

doi:10.1097/ccm.0b013e31828cf104

Cited by 152 publications

(124 citation statements)

References 33 publications

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“…Mortality was lower in the patients receiving prophylaxis, although this did not reach statistical significance [514]. All studies included in the meta-analysis were cited in the 2012 guideline, which recommended pharmacologic prophylaxis.…”

Section: We Suggest Mechanical Vte Prophylaxis When Pharmacologic Vtementioning

confidence: 99%

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Suggest Mechanical Vte Prophylaxis When Pharmacologic Vtementioning

confidence: 99%

“…The incidence of DVT acquired in the ICU may be as high as 10% [512]; the incidence of acquired PE may be 2-4% [513,514]. Patients with sepsis and septic shock are likely at increased risk for this complication.…”

Section: We Suggest Mechanical Vte Prophylaxis When Pharmacologic Vtementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…The results demonstrated that both LDUH and LMWH prevent DVT, and the incidence of DVT did not differ significantly between LDUH and LMWH. [16][17][18] Data from an RCT and the metaanalysis, however, showed that LMWH is superior to LDUH in the prevention of pulmonary embolism. 17,18 In another meta-analysis comparing LDUH and LMWH in acutely ill medical patients, LMWH was superior to LDUH in preventing DVT but no difference was found in the incidence of pulmonary embolism.…”

Section: Supporting Evidencementioning

confidence: 99%

“…[16][17][18] Data from an RCT and the metaanalysis, however, showed that LMWH is superior to LDUH in the prevention of pulmonary embolism. 17,18 In another meta-analysis comparing LDUH and LMWH in acutely ill medical patients, LMWH was superior to LDUH in preventing DVT but no difference was found in the incidence of pulmonary embolism. 19 Researchers in 2 other studies 20,21 compared rivaroxaban and apixaban with LMWH in acutely ill medical patients and concluded that the newer oral anticoagulants offered no benefit over LMWH.…”

Section: Supporting Evidencementioning

confidence: 99%

Preventing Venous Thromboembolism in Adults

2016

Critical Care Nurse

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“…A recent Meta-analysis showed that prophylactic doses of unfractionated heparin (UFH) reduced the risk of DVT and PE by 51% and 53%, respectively, in medical patients with no significant increase in hemorrhage 5 . Several other clinical trials and Meta-analysis have shown efficacy and safety of prophylaxis with UFH and Low-molecular weight heparins (LMWH) for preventing VTE [5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

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2016

IJPSR

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Background: Venous thromboembolism (VTE) is a common complication during and after hospitalization for medical patients. Previous studies have shown that only about one third of high risk medical patients receives VTE prophylaxis. Guidelines such as the one produced by the American college of Chest Physicians (ACCP) are aimed at reducing hospital associated VTE. The objective of this study was to determine the appropriateness of VTE prophylaxis in medical inpatients at a large teaching hospital. Methods: In a prospective cross-sectional study, VTE prophylaxis were evaluated and the data were recorded during October 2014 to March 2015 in medical wards of "Alzahra" hospital, Isfahan, Iran. A caprini score, a VTE risk factor assessment tool was calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data, caprini score and prophylaxis regimen according to the ACCP 9 th edition guideline. Results: A total of 100 patients met the inclusion criteria and were reviewed. According to the risk stratification, 18 patients classified as low risk, 30 as moderate and 47 as high risk. 66% of patients did not receive appropriate prophylaxis in accordance with the guideline. Adherence to VTE prophylaxis for high-risk patients was 100% for pharmacological prophylaxis and 5% for mechanical prophylaxis. Conclusion: VTE prophylaxis was underutilized in high-risk medical inpatients in our center, on the other hand it is overused in low-risk patients. There is a need to implement a program to improve VTE awareness and prophylaxis. Also the hospital should develop a formal strategy, including a local guideline for VTE prevention.

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Heparin Thromboprophylaxis in Medical-Surgical Critically Ill Patients

Cited by 152 publications

References 33 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Preventing Venous Thromboembolism in Adults

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