CURRENT Essentials of Critical Care.pdf

6 Current Essentials of Critical Care■■Deep Venous Thrombosis,Prevention in Medical PatientsEssential Concepts• High deep venous thrombosis (DVT) and pulmonary embolism(PE) risk in surgical or medical patients (15–50%); with myocardialinfarction (24%), strokes• Risk increased by stasis, immobilization, release of thromboplastins,hypercoagulable state (transient or chronic), infection,local venous trauma• Preventive therapy indicated for all patients in ICU, unless contraindicated• Intensity of treatment depends on underlying disease or procedure,risk of DVT, and likelihood of early ambulationEssentials of Management• LDUH subcutaneous low-dose heparin, 5000–7000 units, 2–3times daily; LMWH subcutaneous low molecular weight heparin;ES elastic stockings; SCD sequential compression device• Acute myocardial infarction: LDUH or IV heparin (aPTT46–70 s)• Ischemic stroke with impaired mobility: LDUH or LMWH; ifanticoagulation contraindicated, ES or SCD• Medical illness without contraindication: LDUH or LMWH plusES or SCD; if contraindication, ES plus SCD■ PearlEven patients with hemorrhagic strokes should be considered for DVTprophylaxis, but they should be closely observed to determine if thestroke is extending.ReferenceGeerts WH et al: Prevention of venous thromboembolism. Chest 2001;119(1Suppl):132S. [PMID: 11157647]