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Efficacy of Deep Venous Thrombosis Prophylaxis in the Medical Intensive Care Unit

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, hkhouli{at}chpnet.org

Janet Shapiro, MD

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Vinh Philip Pham, MD

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Asghar Arfaei, MD

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Olanrewaju Esan, MD

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Raymonde Jean, MD

St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Peter Homel, PhD

Albert Einstein College of Medicine, Bronx, New York

The purpose of this study was to determine the incidence of deep venous thrombosis in medical intensive care unit patients receiving deep venous thrombosis prophylaxis. This was a prospective cohort study of 141 consecutive adult patients anticipated to remain in the medical intensive care unit for >48 hours. Deep venous thrombosis prophylaxis was provided using subcutaneous unfractionated heparin or a sequential compression device according to risk-stratified protocol. Compression ultrasound was performed. Fourteen patients (9.9%) developed deep venous thrombosis on follow-up studies. Incidence of deep venous thrombosis was 7.9% per person year (95% confidence interval, 4.8-12.8). Two of 14 developed pulmonary embolism. Eight patients required full anticoagulation with intravenous heparin or coumadin. In-hospital mortality was similar in both groups. Patients with deep venous thrombosis had a statistically higher risk of pulmonary embolism: 14.2% (95% confidence interval, 2.0-43.0) versus 0.0% (95% confidence interval, 0-3; P = .009). Incidence of deep venous thrombosis is high in medical intensive care unit patients receiving standard prophylaxis. Adherence to strict deep venous thrombosis prophylaxis protocol and exploration of other prophylaxis regimens should be pursued.

Key Words: deep venous thrombosis • DVT prophylaxis • pulmonary embolism • sequential compression device • subcutaneous unfractionated heparin • ultrasound

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