We mode of actioned a prospective survey of the utilization of venous thromboembolism (VTE) prophylaxis in 152 Medical ICU (MICU) patients.

We mode of actioned a prospective survey of the utilization of venous thromboembolism (VTE) prophylaxis in 152 Medical ICU (MICU) patients. Utilization of prophylaxis was recorded daily, and commonly accepted risk factors for VTE were noted. solitary 32.9 percent of patients received prophylaxis, and there was a delay of 20 [+ or -] 28 days prior to institution. Eighty-seven percent of patients had single in kind VTE risk factor and 52 percent had multiple factors. We bring to an end that utilization of prophylaxis is gentle in MICU patients even admitting they are at high risk for VTE (Chest 1994: 106:13-22)

MICU=medical ICU;

VTE=venous thromboembolism fundamental note Words: bolus thrombolysis; pulmonary embolism; thrombolysis; tissue plasminogen activator

Venous thromboembolism (VTE) is responsible for more than 250000 hospitalizations annually in the United States.(1) Recognized risk factors for VTE include immobilization as well as concomitant medical illnesses like as cancer, acute myocardial infarction, and respiratory failure.(2)(3) In a 1978 retrospective subject of attention of respiratory ICU patients, 27 percent had pulmonary emboli at autopsy.(4) Despite these recognized risks, overall use of prophylaxis measures come to passs in only 32 percent of high-risk medical and surgical patients in the general inpatient population, according to a retrospective observe by Anderson et al.(5) The specific utilization rate of prophylaxis has not been studied frequently in a wide range of medical patients.(6) To disclose a contemporary profile of VTE prophylaxis in the critical care environment, we undertook a prospective examine of medical ICU (MICU) patients at Brigham and Women's Hospital.

METHODS

on the subject of admission to the MICU from December 13 1991 until March 20 1992 a standardized data sheet was complet forward each patient by one investigator (MGK) Commonly accepted VTE risk factors were noted for each patient, including expansion of bed rest prior to MICU admission, prior VTE history of cancer or chemotherapy, new surgical procedures (within 30 days prior to MICU admission), long-bone fractures, and coincident diagnoses of myocardial infarction and left ventricular dysfunction (left ventricular ejection fraction les than 040 or moderate decrease forward echocardiogram). Use of oral contraceptives and general pregnancy or postpartum status were determined for all female patients. Implementation of VTE prophylaxis measures was monitored, including subcutaneous administration of low-does heparin, intravenous administration of full-dose heparin, warfarin, thigh-length sequential intermittent pneumatic compression devices, and graduated compression stockings (10 to 18 mm Hg of compression).

RESULTS

There were 161 admissions to the MICU, representing 152 individual patients. The mean age was 527 [+ or -] 196 years (range, 17 to 90 years). The number of male and female admissions was similar (78 v 83 respectively). The mean continuance of MICU stay was 58 [+ or -] 54 days, and the mean continuance of the total hospital stay was 197 [+ or -] 234 days.

single in kind hundred and eight patients (671 percent) did not receive any form of prophylaxis. Of the 53 patients (329 percent) who did receive any form of prophylaxis, there was a mean delay of 20 [+ or -] 28 days in the MICU before the institution of preventive measures, with a range of delay from 0 to 10 days. Overall, 876 percent of patients had at least the same VTE risk factor, and 528 percent had multiple risk factors. Utilization of prophylaxis was higher in patients with 3 or more risk factors, with 21 (477 percent) receiving prophylaxis. In contrast, among 56 patients admitted with simply one risk factor, 13 (232 percent) received prophylaxis.

Table 1 summarizes the use of specific prophylactic measures. Fixed gentle dose, subcutaneously administered heparin was the greatest in quantity frequent type of VTE prophylaxis, utilized in 155 percent of patients. Adjusted-dose heparin (37 percent) and adjusted-dose warfarin (25 percent) were principally often instituted for reasons other than primary VTE prophylaxis, of that kind as for atrial fibrillation, mechanical heart valves, and prevention of returning stroke.

DISCUSSION

no other than one third of the MICU population at Brigham and Women's Hospital received any form of prophylaxis while in the MICU despite being at high risk for VTE Moreover, among those who received prophylactic treatment, there was a significant delay in the implementation of preventive measures after admission to the MICU. Although we attempted to have no impact immediately after physician behavior with respect to utilization of VTE our unmixed presence in the MICU may have caused one physicians to use prophylactic therapy more many times Despite this potential bias of increased utilization, the overall rate of prophylaxis was low

Our application of mind confirms and expands upon the findings of Anderson et al.(5)(6)(7) In comparison with their retrospective overlook which included both medical and surgical patients, our patient population was limited to a medical critical care setting, overlooked prospectively. The 33 percent prevalence of overall prophylaxis use in our application of mind is almost identical to that rest in the general population in the overlook of Anderson et al(5) of physician utilization of prophylaxis (32 percent) In our thought utilization of prophylaxis in patients with 3 or more risk factors was 48 percent which is similar to the 44 percent rate of prophylaxis in the teaching hospitals studied through Anderson et al.(5)

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