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Thromboembolism in the Intensive Care Unit

  • Paul Ellis Marik

Abstract

Deep venous thrombosis (DVT) and pulmonary emboli are in reality one and the same disease, thromboembolic disease, as a large proportion of patients with DVT have “asymptomatic” PE. Critically ill ICU patients have many of the risk factors that increase the risk of DVT, including prolonged venous stasis caused by bed rest, cardiac failure, dehydration, obesity, and advanced age. Consequently, routine DVT prophylaxis is recommended in all ICU patients; i. e., every ICU patient should receive DVT prophylaxis. Patients with femoral venous catheters may be at an increased risk of thromboembolism, and DVT prophylaxis is therefore particularly important in this group of patients. For practical purposes, it is convenient to group the patients according to the risk of DVT (Table 13–1). It should be appreciated that the improper use and/or application of intermittent compression devices will result in ineffective prophylaxis. Routine screening for DVT is not cost-effective in ICU patients who are receiving DVT prophylaxis. However, a high index of suspicion for DVT should exist with a low threshold for performing venous Doppler ultrasonography. Recently, aspirin has been demonstrated to have utility in DVT prophylaxis. However, the role of this agent in ICU patients who are at an increased risk of gastric stress ulceration is unclear.

Keywords

Pulmonary Embolism Inferior Vena Caval International Normalize Ratio Deep Venous Thrombosis Thrombolytic Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Selected References

  1. 1.
    Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism: a comprehensive review of current evidence. Chest. 1999;115:1695–1707.PubMedCrossRefGoogle Scholar
  2. 2.
    Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d’Embolie Pul- monaire par Interruption Cave Study Group. N Engl J Med. 1998;338:409–415.PubMedCrossRefGoogle Scholar
  3. 3.
    Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993;341:507–511.PubMedCrossRefGoogle Scholar
  4. 4.
    Goldhaber SZ. Pulmonary embolism. N Engl J Med. 1998;339:93–104.PubMedCrossRefGoogle Scholar
  5. 5.
    Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low- molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1999;130:800–809.PubMedGoogle Scholar
  6. 6.
    Joynt GM, Kew J, Gomersall CD, Leung VY, Liu EK. Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest. 2000;117:178–183.PubMedCrossRefGoogle Scholar
  7. 7.
    Konstantinides S, Geibel A, Olschewski M, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation. 1997;96:882–888.PubMedGoogle Scholar
  8. 8.
    Levin JM, Schiff D, Loeffler JS, et al. Complications of therapy for venous thromboembolic disease in patients with brain tumors. Neurology. 1993; 43:1111–1114.PubMedGoogle Scholar
  9. 9.
    Marik PE, Andrews L, Maini B. The incidence of deep venous thrombosis in ICU patients. Chest. 1997;111:661–664.PubMedCrossRefGoogle Scholar
  10. 10.
    Meneveau N, Schiele F, Metz D, et al. Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. JAm Coll Cardiol. 1998;31:1057–1063.CrossRefGoogle Scholar
  11. 11.
    Meyer G, Gisselbrecht M, Diehl JL, Journois D, Sors H. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. Am J Med. 1998;105:472--477.PubMedCrossRefGoogle Scholar
  12. 12.
    Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial.Lancet. 2000;355:1295–1302.Google Scholar
  13. 13.
    Quevedo JF, Buckner JC, Schmidt JL, Dinapoli RP, O’Fallon JR. Thromboembolism in patients with high-grade glioma. Mayo Clin Proc. 1994; 69:329–332.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Paul Ellis Marik
    • 1
  1. 1.Critical Care MedicineMercy Hospital of PittsburghPittsburghUSA

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