Thromboprophylaxis in medical-surgical critically ill patients

Although critically ill patients are at high risk of venous thromboembolism and bleeding, and thromboprophlyaxis is of proven effectivity in other settings, there remain relatively few data to assist clinicians in providing evidence-based care for medical-surgical patients in the intensive care unit.

Deep vein thrombosis occurs in 5-10% of critically ill patients even if they receive unfractionated heparin for prophylaxis. Both heparin and low molecular weight heparin can be safely administered to the majority of critically ill patients and the low molecular weight heparin dalteparin does not appear to bioaccumulate even when administered to patients with severe renal dysfunction. Further research is currently underway to better define how these conditions can be optimally treated.

Despite the high morbidity and mortality because of critical illness, the risk of venous thromboembolism in these patients, and adverse outcomes due to venous thromboembolism, much more methodologically rigorous data are required in the form of large, well designed randomized trials before firm recommendations about prophylaxis can be provided to this highly vulnerable population.