Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

2019 ◽  
Vol 39 (3) ◽  
pp. 232-241 ◽  
Author(s):  
Paul M. Reynolds ◽  
Edward T. Van Matre ◽  
Garth C. Wright ◽  
Robert Brett McQueen ◽  
Ellen L. Burnham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Critically Ill Patient ◽  
Heparin Dosage

Venous Thromboembolism Prophylaxis: A Narrative Review With a Focus on the High-Risk Critically Ill Patient

2018 ◽  
Vol 34 (11-12) ◽  
pp. 877-888 ◽  
Author(s):  
Tyler C. Lewis ◽  
Jennifer Cortes ◽  
Diana Altshuler ◽  
John Papadopoulos
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Health Concern ◽  
Fixed Dose ◽  
Critically Ill Patient ◽  
Increased Risk

Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality. Clinical practice guidelines therefore recommend VTE prophylaxis with either subcutaneous heparin or low-molecular-weight heparin for all critically ill patients without contraindication. Yet, many patients will develop VTE despite appropriate pharmacologic prophylaxis, which has led to interest in risk-stratifying critically ill patients for more aggressive prophylaxis strategies. Recent research identified patients at highest risk of failure of thromboprophylaxis and provided insight into the pathophysiologic mechanisms. Obesity and the receipt of vasopressors are 2 risk factors consistently identified in observational studies; further clinical data support decreased absorption of anticoagulant administered via the subcutaneous route as the likely mechanism behind thromboprophylaxis failure in these patient populations. Several studies have investigated novel thromboprophylaxis strategies to circumvent pharmacokinetic limitations in patients who are obese or on vasopressors: increased fixed-dose, weight-based subcutaneous, or continuous intravenous infusion of a prophylactic dose of anticoagulant has shown promise in limited studies; however, the results have yet to demonstrate superiority compared to current standard-of-care. This review discusses observational studies identifying patients at risk of thromboprophylaxis failure and critiques clinical studies evaluating novel thromboprophylaxis strategies in high-risk, critically ill patients with a focus on their limitations. Future studies are currently being conducted that will provide further guidance into the appropriate use of individualized thromboprophylaxis.

Incidence and Risk Factors for Venous Thromboembolism in Critically Ill Children After Trauma

2010 ◽  
Vol 68 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Sheila J. Hanson ◽  
Rowena C. Punzalan ◽  
Rachel A. Greenup ◽  
Hua Liu ◽  
Thomas T. Sato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Critically Ill Children

scholarly journals Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome

2019 ◽  
Vol 63 (5) ◽  
pp. 630-638 ◽  
Author(s):  
Sigrid Beitland ◽  
Henning Wimmer ◽  
Torleif Lorentsen ◽  
Dag Jacobsen ◽  
Tomas Drægni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Observational Study ◽  
Critically Ill ◽  
Prospective Observational Study

Incidence and Risk Factors for Venous Thromboembolism in Critically Ill Children With Cardiac Disease

2011 ◽  
Vol 33 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Sheila J. Hanson ◽  
Rowena C. Punzalan ◽  
Melissa A. Christensen ◽  
Nancy S. Ghanayem ◽  
Evelyn M. Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critically Ill Children

Risk factors for venous thromboembolism in critically ill nontrauma surgical patients who cannot receive chemical prophylaxis

2013 ◽  
Vol 206 (3) ◽  
pp. 300-306
Author(s):  
Madhukar S. Patel ◽  
Tyler Ewing ◽  
Allen Kong ◽  
David Nguyen ◽  
Cecilia Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Surgical Patients ◽  
Chemical Prophylaxis

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation

2017 ◽  
Vol 28 (2) ◽  
pp. 234-242 ◽  
Author(s):  
Christie M. Atchison ◽  
Ernest Amankwah ◽  
Jean Wilhelm ◽  
Shilpa Arlikar ◽  
Brian R. Branchford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Critically Ill ◽  
Odds Ratio ◽  
Cardiothoracic Surgery ◽  
Critically Ill Children ◽  
Cardiovascular Intensive Care

AbstractBackgroundPaediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.ObjectiveThe aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.MethodsWe conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.ResultsAmong 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.ConclusionMajor infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis

Injury ◽  
2013 ◽  
Vol 44 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Darren Malinoski ◽  
Tyler Ewing ◽  
Madhukar S. Patel ◽  
Fariba Jafari ◽  
Bryan Sloane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Trauma Patients ◽  
Chemical Prophylaxis

Abstract 128: Risk Factors for Hospital-associated Venous Thromboembolism in Critically-ill Children with Cardiac Disease Undergoing Cardiothoracic Surgery or Cardiac Catheter-based Therapeutic Intervention

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Christie Atchison ◽  
Ernest Amankwah ◽  
Jean Wilhelm ◽  
Shilpa Arkilar ◽  
Arabela Stock ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Risk Score ◽  
Cardiac Disease ◽  
Multivariate Model ◽  
Critically Ill Children ◽  
Major Infection ◽  
Independent Risk Factors

Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) has dramatically risen in recent years. Children with congenital or acquired heart disease are at particular risk and have not been addressed by recent, novel retrospectively-derived risk scores. Aims: We sought to develop a risk model for HA-VTE in critically-ill children with cardiac disease. Methods: We conducted a retrospective, case-control study of children admitted to the CVICU at All Children's Hospital Johns Hopkins Medicine (St. Petersburg, FL, USA) from January 2006 - April 2013. We identified cases via ICD-9 codes, and employed case validation via review of radiologic records. Two controls were randomly selected for each case. Associations between putative risk factors and HA-VTE were estimated using odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs) from univariate and multivariate logistic regression analyses. Variables with P-values < 0.1 in univariate analyses were included in the multivariate model. A HA-VTE risk score was developed with weighting based on the relative magnitudes of the individual ORs from the multivariate model. Results: After adjustment in a multiple logistic regression, length of stay (LOS) >30 days, cardiac catheterization, and major infection were found to be statistically-significant independent risk factors for HA-VTE in these children. An 8-point risk score was developed in which scores of 0-1, 2-6, and 7-8 yielded HA-VTE risks of < 1%, 1-< 2%, and ≥2%, corresponding to conventional thresholds for instituting no prophylaxis, mechanical prophylaxis, and pharmacological prophylaxis (respectively) in hospitalized adults. Conclusions: LOS >30 days, cardiac catheterization, and major infection are significant independent risk factors for HA-VTE in critically-ill children with cardiac disease leading to the development of a novel HA-VTE risk score in this population. If prospectively validated, this risk score will inform the design of risk-stratified clinical trials of HA-VTE prevention.

scholarly journals Incidence, risk factors and outcome of venous thromboembolism in critically ill obstetric patients

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P504
Author(s):  
C Kaddour ◽  
R Souissi ◽  
Z Haddad ◽  
M Soussi ◽  
M Magouri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Incidence Risk
Sign in / Sign up

Export Citation Format

Share Document