Failure of Chemical Thromboprophylaxis in Critically Ill Medical and Surgical Patients with Sepsis

Abstract Purpose Critically ill patients who develop sepsis may be at a higher risk of venous thromboembolism (VTE) prophylaxis failure, however, studies in this population are limited. The objective of this study was to identify the incidence of VTE prophylaxis failure in this population. Methods T...

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Bibliographic Details
Published in:Journal of critical care 2017-02, Vol.37, p.206-210
Main Authors: Hanify, Jennifer M., Pharm.D, Johnson, Donald W., Pharm.D., BCPS, Dupree, Lori H., Pharm.D., BCPS, Ferreira, Jason A., Pharm.D., BCPS
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Acute respiratory distress syndrome
Aged
Anesthesia
Anticoagulant
Anticoagulants - therapeutic use
Blood transfusions
Body mass index
Bone surgery
Catheters
Compression therapy
Critical Care
Critical Illness
Critically ill
Enoxaparin - therapeutic use
Family medical history
Female
Funding
Heparin - therapeutic use
Hospitalization
Hospitals
Humans
Incidence
Intensive Care Units
Length of Stay
Logistic Models
Male
Middle Aged
Molecular weight
Mortality
Mutation
Odds Ratio
Positive-Pressure Respiration
Respiratory Distress Syndrome, Adult - epidemiology
Retrospective Studies
Risk Factors
Sepsis
Sepsis - epidemiology
Sepsis - therapy
Thromboprophylaxis
Treatment Failure
Venous thromboembolism
Venous Thromboembolism - epidemiology
Venous Thromboembolism - prevention & control
Ventilation
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Summary:Abstract Purpose Critically ill patients who develop sepsis may be at a higher risk of venous thromboembolism (VTE) prophylaxis failure, however, studies in this population are limited. The objective of this study was to identify the incidence of VTE prophylaxis failure in this population. Methods This retrospective review of patients admitted to the intensive care unit (ICU) between February 2013 and September 2015 included patients who were diagnosed with sepsis and received heparin or enoxaparin VTE prophylaxis. Results Of the 355 patients included, 42 (12.5%) developed a VTE. Acute respiratory distress syndrome (ARDS) (31% vs 16.7%, P = .0272) and higher positive end expiratory pressure (10 vs 8, P = .0066) were associated with increased risk of VTE prophylaxis failure. Logistic regression identified ARDS an event risk factor (OR 2.58, 95% CI 1.22–5.42). VTE was associated with an increased ICU (14 vs 9 days, P = .01) and hospital length of stay (26 vs 15 days, P < .0001). The median time from sepsis diagnosis to VTE event was 9 days (IQR 5–13). Conclusion Critically ill patients with sepsis had a high rate of VTE prophylaxis failure with ARDS being identified as a risk factor for VTE prophylaxis failure.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2016.10.002