Is There a Rationale to Use Thromboprophylaxis in Critically Ill Patients?
Thromboprophylaxis is recommended in the general surgical and medical populations. In the ICU, three randomized controlled trials (RCTs), comparing thromboprophylaxis with placebo using objective screening for DVT (Table 4), found that the rate of DVT was significantly lower in the thromboprophylaxis group regardless of the thromboprophylaxis used, UFH or LMWH. The American College of Chest Physicians (ACCP) recommends thromboprophylaxis for prevention of VTE in critical care patients (grade Ia: strong recommendation with high quality of evidence). Moreover, omission of thromboprophylaxis within the first 24 hours of ICU admission without obvious reasons is associated with a higher risk of mortality in the ICU.
In the ICU, up to 80 % of patients under thromboprophylaxis have at least one episode of bleeding, more often minor. Major bleeding is described in 5.6 % of critically ill patients with or without preventive anticoagulation, and up to 7.2 % when dalteparin is used in severe renal insufficiency patients.