Venous Thromboembolism, Prophylaxis, and Treatment (Including Fat Embolism Syndrome)

Chapter

Abstract

DVT (deep venous thrombosis) and PE (pulmonary embolism), collectively known as VTE (venous thromboembolism), are common in critically ill patients. With proper prophylaxis, VTE is preventable in many patients. Critically ill patients are at high risk due to their underlying disease state and secondary to vasopressor use, venous catheterization, sedation, and/or mechanical ventilation. Most (if not all) ICU patients require pharmacologic prophylaxis unless contraindicated. If contraindicated, mechanical prophylaxis with sequential compression devices or, less commonly, IVC (inferior vena cava) filters can be used. Diagnosis is challenging as VTE often presents with non-specific findings. Gold standard for diagnosis remains duplex ultrasound for DVT and CT pulmonary angiography for PE. Evaluation by echocardiogram can help determine severity of the PE. Therapeutic anticoagulation remains the basic cornerstone treatment for VTE. Some patients may also require catheter-directed or surgical therapies for those who manifest with cardiac or hemodynamic compromise. Appropriate risk stratification, prophylactic measures, proper diagnostic workup, and treatment are critical for the care of ICU patients.

Keywords

Venous thromboembolism Deep vein thrombosis Fat embolism Fat embolism syndrome Pulmonary embolism Venous thromboembolism prophylaxis Surgical critical care Intensive care unit 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Surgery, Anesthesiology/Critical Care Medicine (ACCM), and Emergency MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA

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