Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU). Thromboprophylaxis is mainly performed with Low Molecular Weight Heparin (LMWH) and, in some specific patients, with Unfractionated Heparin (UFH). These intensive units are an environment where individual patient variability is extreme and where traditional antithrombotic protocols are frequently ineffective. This was known for a long time, but the hospitalization of many patients with COVID-19 inflammatory storms suddenly highlighted this knowledge. It is therefore reasonable to propose variable antithrombotic prevention protocols based initially on a series of individual criteria (weight, BMI, and thrombotic risks). Secondly, they should be adjusted by the monitoring of anticoagulant activity, preferably by measuring the anti-Xa activity. However, we still face unresolved questions, such as once- or twice-daily LMWH injections, monitoring at the peak and/or trough, and poorly defined therapeutic targets. Equally surprisingly, we observed a lack of standardization of the anti-Xa activity kits.
Highlights
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU) and is associated with increased morbidity and mortality in these particular patients
This study showed no difference in the occurrence of deep venous thrombosis (5.1 versus 5.8% for Unfractionated Heparin (UFH)) but a decrease of the rates of pulmonary embolism (1.3% for Low Molecular Weight Heparin (LMWH) versus 2.3% for UFH; p = 0.01) and heparininduced thrombocytopenia (HIT) in the patients who received LMWH [8]
Failure was more likely reported in ICU patients with elevated body mass indexes, those with a personal or family history of venous thromboembolism, and those receiving vasopressors
Summary
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU) and is associated with increased morbidity and mortality in these particular patients. In the observational IMPROVE study including 15,156 medical patients, Spyropoulos et al [1] reported that admission to an ICU or coronary care unit was a factor independently associated with VTE. Several other factors know to increase the risk of VTE were present in ICU patients: older age, prolonged immobilization due to sedation, mechanical ventilation, central venous catheterization [2], and severe inflammation-like observed during sepsis [3]. The recent pandemic due to coronavirus disease 2019 (COVID-19), where the risk of VTE in hypoxic critically ill patients is even greater, reaffirms the importance of adequate thromboprophylaxis. Biomedicines 2021, 9, 864 others, higher levels of inflammation, endotheliitis, and increased production of neutrophil extracellular traps) [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
