Journal of Critical Care
Volume 22, Issue 4 , Pages 285-289, December 2007

Venous thromboembolism in critical illness in a community intensive care unit☆☆☆★

  • John G. Muscedere, MD, FRCPC

      Affiliations

    • Department of Medicine, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada K7L 2V7
    • Corresponding Author InformationCorresponding author. Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7.
    • ,
  • Daren K. Heyland, MD, FRCPC, MSc

      Affiliations

    • Department of Medicine, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada K7L 2V7
    • ,
  • Deborah Cook, MD, FRCPC, Msc

      Affiliations

    • McMaster University, Hamilton, Canada

published online 05 July 2007.

Abstract 

Background

Venous thromboembolism (VTE) can be a life-threatening complication of critical illness. Venous thromboembolism rates observed depend on the population studied, the screening modality used, and thromboprophylaxis prescribed. Few studies report on the rates of clinically diagnosed VTE in critically ill patients. The purpose of this study was to characterize the incidence of clinically diagnosed VTE, prophylactic strategies used, and diagnostic studies ordered in a critically ill population at a tertiary community intensive care unit (ICU), both during and after their ICU stay.

Methods

We did a retrospective chart review of 600 consecutive critically ill patients admitted to a tertiary community ICU.

Results

Fifty (8.3%) patients developed VTE over the course of their ICU and hospital stay (18 [3.0%] patients during their ICU stay and 32 [5.7% of 561 ICU survivors] patients after ICU discharge). By ICU admission diagnosis, most events occurred in neurosurgical patients, although this group comprised only 24.8% of the population. Across all subgroups, most VTE events occurred after ICU discharge. Intensive care unit patients received thromboprophylaxis 87.6% (95% confidence interval, 81.5-93.7) of the time spent in ICU. However, thromboprophylaxis was administered significantly less often after transfer to the ward compared with within the ICU (from 87.6% to 59.8%, P < .001).

Conclusion

The rates of clinically diagnosed VTE rates in critically ill patients are substantial. Venous thromboembolism occurs before, during, and after ICU discharge. Continued vigilance and thromboprophylaxis are warranted across the continuum of critical illness.

Keywords: Venous thromboembolism, Thromboprophylaxis, Intensive care unit

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☆ Data collection was conducted at Hotel-Dieu Grace Hospital, Windsor, Ontario, Canada. Data analysis and manuscript preparation performed at Queen's University, Kingston, Canada, and McMaster University, Hamilton, Canada.

☆☆ This study was supported by the Physician's Services Incorporated Foundation of Ontario, Ontario, Canada.

★ J Muscedere and D Cook received study medication from Pfizer, Inc (Kirkland, Quebec, Canada) for use in a peer-review funded randomized trial testing heparin thromboprophylaxis. D. Cook received an arm's-length grant-in-aid from Pfizer, Inc for an unrelated observational study on thromboprophylaxis. D. Heyland has no conflicts to disclose.

PII: S0883-9441(07)00040-8

doi:10.1016/j.jcrc.2007.02.003

Journal of Critical Care
Volume 22, Issue 4 , Pages 285-289, December 2007

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