Omission of Early Thromboprophylaxis and Mortality in Critically ill Patients: a Multicenter Registry Study.
Chest. 2011 Sep 22;
Authors: Ho KM, Chavan S, Pilcher D
ABSTRACT BACKGROUND:Venous thromboembolism is an important preventable cause of death within hospitals. This study aimed to assess the association between omission of early thromboprophylaxis for more than 24 hours after intensive care unit (ICU) admission and mortality in critically ill patients. METHODS AND RESULTS:This study involved a total of 175,665 critically ill adult patients admitted to 134 ICUs between 2006 and 2010. The crude ICU and hospital mortality in patients who did not receive thromboprophylaxis within 24 hours of ICU admission was higher than those who were treated with early thromboprophylaxis (7.6% versus 6.3%, p=0.001; 11.2% versus 10.6%, p=0.003, respectively), despite the former patients were associated with a slightly lower acuity of illness (mean Acute Physiology and Chronic Health Evaluation III model predicted mortality 13% versus 14%, p=0.001). The association between omission of early thromboprophylaxis and hospital mortality remained significant after adjusting for other covariates (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.15-1.30, p=0.001), particularly for patients with multiple trauma, sepsis, cardiac arrest, and pre-existing metastatic cancer. The estimated attributable mortality effect of omitting early thromboprophylaxis for patients with multiple trauma, sepsis, cardiac arrest and pre-existing metastatic cancer was 3.9% (95%CI 2.2-5.6), 8.0% (95%CI 5.6-10.4), 15.4% (95%CI 11.1-19.8) and 9.4% (95%CI 6.4-12.4), respectively. CONCLUSIONS:Omission of thromboprophylaxis within the first 24 hours of ICU admission without obvious reasons was associated with an increased risk of mortality in critically ill adult patients.
PMID: 21940768 [PubMed - as supplied by publisher]