Thromboembolism in the Intensive Care Unit

Abstract

Deep venous thrombosis (DVT) and pulmonary emboli are in reality one and the same disease, thromboembolic disease, as a large proportion of patients with DVT have “asymptomatic” PE. Critically ill ICU patients have many of the risk factors that increase the risk of DVT, including prolonged venous stasis caused by bed rest, cardiac failure, dehydration, obesity, and advanced age. Consequently, routine DVT prophylaxis is recommended in all ICU patients; i. e., every ICU patient should receive DVT prophylaxis. Patients with femoral venous catheters may be at an increased risk of thromboembolism, and DVT prophylaxis is therefore particularly important in this group of patients. For practical purposes, it is convenient to group the patients according to the risk of DVT (Table 13–1). It should be appreciated that the improper use and/or application of intermittent compression devices will result in ineffective prophylaxis. Routine screening for DVT is not cost-effective in ICU patients who are receiving DVT prophylaxis. However, a high index of suspicion for DVT should exist with a low threshold for performing venous Doppler ultrasonography. Recently, aspirin has been demonstrated to have utility in DVT prophylaxis. However, the role of this agent in ICU patients who are at an increased risk of gastric stress ulceration is unclear.