Journal of Critical Care
Volume 21, Issue 2 , Pages 173-178, June 2006

Prophylactic low-molecular-weight heparin: Prescription practice in an intensive care unit

  • Patrick Tilleul

      Affiliations

    • APHP Pharmacie, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • ,
  • Gaëlle Tredan

      Affiliations

    • APHP Pharmacie, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • ,
  • Géraldine Austruy

      Affiliations

    • APHP Pharmacie, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • ,
  • Eric Maury

      Affiliations

    • APHP Service de Réanimation Médicale, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • INSERM U707, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • ,
  • Georges Offenstadt

      Affiliations

    • APHP Service de Réanimation Médicale, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • INSERM U707, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • Universite Pierre et Marie Curie, 75012 Paris, France
    • ,
  • Bertrand Guidet

      Affiliations

    • APHP Service de Réanimation Médicale, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • INSERM U707, Hôpital Saint Antoine, 75571 Paris cx 12, France
    • Universite Pierre et Marie Curie, 75012 Paris, France
    • Corresponding Author InformationCorresponding author. Intensive Care Unit, Hôpital Saint-Antoine, 75012 Paris, France. Tel.: +33 1 49 28 23 18; fax: +33 1 49 28 21 45.

Abstract 

Aim

The aim of this study was to review the use of low-molecular-weight heparin (LMWH) in a medical intensive care unit.

Materials and Methods

Double-blind prospective study conducted in a 14-bed intensive care unit, covering all patients admitted over a 2-month period. A comparison with 2 guidelines based on indication, age of the patient, kidney function, platelet count, and duration of treatment was performed. Bleeding complication and clinically diagnosed phlebitis episodes were collected.

Results

One hundred thirty-six patients (71 treated with LMWH and 65 untreated) were included in the study (mean age, 60 ± 18 years; SAPS (Simplified Acute Physiology Score) II, 39 ± 23). Among treated patients, 9 were overtreated (13%), and among nontreated patients, 13 were undertreated (20%). In the cohort of treated patients, reasons for failure to comply with recommendations included age of the patient (30%), creatinine clearance (18%), platelet count (32.4%), and duration of treatment (12.7%). Low-molecular-weight heparin prescriptions were conforming to the 4 criteria in 35.2% of patients, to 3 in 43.7%, to 2 in 19.7%, and to 1 in 1.4%.

Conclusion

The prescription of prophylactic LMWH in intensive care has become a routine. Our study shows that over- and underprescription are common together with misuse.

Keywords: Prescription practice, Low-molecular-weight heparin, Intensive care unit

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PII: S0883-9441(06)00038-4

doi:10.1016/j.jcrc.2005.12.013

Journal of Critical Care
Volume 21, Issue 2 , Pages 173-178, June 2006

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