Thrombosis Prophylaxis and Mortality Risk among Critically Ill Adults.
Chest. 2014 Apr 10;
Authors: Lilly CM, Liu X, Badawi O, Franey CS, Zuckerman IH
ABSTRACT BACKGROUND: The optimal approach for managing increased risk of venous thromboembolism (VTE) among critically ill adults is unknown.
METHODS: An observational study of 294,896 episodes of critical illness among adults was conducted in 271 geographically dispersed United States adult intensive care units. The primary outcomes were all cause ICU and in-hospital mortality after adjustment for acuity and other factors among groups of patients assigned, based on clinical judgment, to prophylactic anticoagulation, mechanical devices, both or neither. Outcomes of those managed with prophylactic anticoagulation or mechanical devices were compared in a separate paired propensity matched cohort.
RESULTS: After adjustment for propensity to receive VTE prophylaxis, APACHE IV scores and management with mechanical ventilation, the group treated with prophylactic anticoagulation was the only one with significantly lower risk of dying than those not provided VTE prophylaxis (ICU; 0.81 (0.79 to 0.84), p<.0001; hospital; 0.84 (0.82 to 0.86), p<.0001). The mortality risk of those receiving mechanical devices was not lower than that of patients without VTE prophylaxis. A study of 87,107 pairs of patients matched for propensity to receive VTE prophylaxis found that those managed with prophylactic anticoagulation had significantly lower risk of death (ICU sub-hazard ratio 0.82 [95% CI, 0.78 to 0.85]; p < .001 hospital sub-hazard ratio 0.82 [95% CI, 0.79 to 0.85]; p < .001) than those receiving only mechanical device prophylaxis.
CONCLUSIONS: These findings support a recommendation for prophylactic anticoagulation in preference to mechanical device prophylaxis for critically ill adults that do not have a contraindication to anticoagulation.
PMID: 24722879 [PubMed - as supplied by publisher]