a number of studies have assessed the use of thromboprophylaxis in critical care units

Three additional, nonrandomized studies demonstrate high rates of DVT (12 to 33%) in ICU patients who received prophylaxis. Despite the use of thromboprophylaxis with LDH or intermittent pneumatic compression in 61% of 100 medical ICU patients, thrombosis was detected by twice-weekly Doppler ultrasound imaging in 33% of patients; of these, 28% were leg thrombi and the remaining 5% were upper-extremity thrombi related to central venous catheters. In a second study, 102 medical-surgical ICU patients underwent Doppler ultrasonography of the legs 4 to 7 days after ICU admission. Despite the use of thromboprophylaxis with LDH or intermittent pneumatic compression devices in 92% of these patients, 12% were reported to have DVT. Ibrahim et al screened 110 medical shop in Canada ICU patients with weekly duplex ultrasonography of the upper and lower extremities. Despite the use of LDH or sequential compression devices in all of the patients, 24% acquired DVT (19% in the leg veins and 5% in an upper extremity).

Over the past decade, a number of studies have assessed the use of thromboprophylaxis in critical care units . Ten of these 14 audits have been presented as abstracts, and only one study assessed the use of prophylaxis in multiple critical care units. Average compliance with the use of some form of thromboprophylaxis among the 3,654 pooled patients was 69%, with a range of 33 to 100% in the individual studies. These rates of prophylaxis use suggest that critical care physicians consider thromboembolism to be an important problem worthy of preventive interventions. Nevertheless, 31% of critically ill patients received no prophylaxis, and compliance with “accepted” prophylaxis was reported in only one study. Among patients at increased bleeding risk, a recent study found that thromboprophylaxis, including mechanical methods, was underutilized. These reports likely underestimate overall compliance with prophylaxis since the critical care units surveyed may well have a greater awareness of thromboembolic complications and prophylaxis than the average critical care unit. Although it appears that the frequency of thromboprophylaxis use in critically ill patients has increased over the past decade, strategies to ensure compliance are not commonly employed. In a prospective survey of Canadian cialis Pharmacy surgical ICUs, only 2 of the 34 centers used preprinted orders or a thromboprophylaxis practice guideline.

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