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Venous Thromboembolism in the Intensive Care Unit

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Principles of Adult Surgical Critical Care

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Abstract

Venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE), or both, is common among critically ill surgical patients and potentially preventable in many cases. Despite high-quality evidence-based guidelines for VTE prophylaxis, many patients do not receive risk-appropriate prophylaxis, and over 100,000 people continue to die from VTE in the United States (US) each year. Critical care patients are at even higher risk for VTE than other hospitalized patients secondary to additional risk factors including vasopressor use, mechanical ventilation, pharmacologic sedation, immobilization, surgery, and central venous catheters. Furthermore, VTE is often clinically silent among critical care patients and timely diagnosis may be challenging. Duplex ultrasonography and contrast-enhanced computed tomography (CT) angiography are the best modalities for diagnosis of DVT and PE, respectively. Severity of PE may be evaluated with transthoracic or transesophageal echocardiography. The mainstay of treatment for DVT and PE is systemic anticoagulation, although patients with PE and associated hemodynamic instability or cardiac failure may require more invasive treatment interventions. Management of VTE in the intensive care unit (ICU) is complicated because many patients have high risk of bleeding from concomitant major surgery, trauma, coagulopathy, or gastrointestinal bleeding. All ICU patients require risk-appropriate VTE prophylaxis because all ICU patients are at risk for VTE. The majority of patients should receive pharmacologic prophylaxis, although some will have a contraindication and should receive mechanical sequential compression devices instead. It is important to recognize risk factors, prescribe and administer effective prophylaxis, and provide timely diagnosis and treatment for patients with VTE in the ICU.

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Abbreviations

AAOS:

The American Academy of Orthopaedic Surgeons

ACCP:

The American College of Chest Physicians

AHRQ:

The Agency for Healthcare Research and Quality

CT:

Computed tomography

DVT:

Deep vein thrombosis

EAST:

The Eastern Association for the Surgery of Trauma

ECMO:

Extracorporeal membrane oxygenation

ICU:

Intensive care unit

INR:

International normalized ratio

IVC:

Inferior vena cava

LMWH:

Low molecular weight heparin

PE:

Pulmonary embolism

SC:

Subcutaneous

SCDs:

Sequential compression devices

TEDS:

Thromboembolic deterrent stockings

US:

United States

V/Q scan:

Ventilation/perfusion scan

VTE:

Venous thromboembolism

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Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Lisa M. Kodadek MD

  2. Division of Acute Care Surgery, Department of Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine, Johns Hopkins University School of Medicine, Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA

    Elliott R. Haut MD, PhD

Authors
  1. Lisa M. Kodadek MD
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  2. Elliott R. Haut MD, PhD
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Correspondence to Elliott R. Haut MD, PhD .

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Editors and Affiliations

  1. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Niels D. Martin

  2. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lewis J. Kaplan

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Kodadek, L.M., Haut, E.R. (2016). Venous Thromboembolism in the Intensive Care Unit. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_28

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  • DOI: https://doi.org/10.1007/978-3-319-33341-0_28

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