Efficacy of deep venous thrombosis prophylaxis in the medical intensive care unit: A systemic review

Introduction: Venous thromboembolism (VTE) is an important and potentially avoidable cause of morbidity and mortality in hospitalized patients. The management of deep vein thrombosis (DVT) prophylaxis in medical intensive care unit patients (MICU) is limited by the lack of studies specific to this patient population. Objectives: To review clinical trials of efficacy of thromboprophylaxis in MICU patients and to provide summary recommendations. Methods: Systemic review of an online search of PubMed, Medline, Cochrane Library, Google Scholar, and selected studies. Results: Randomized placebo-controlled trials reported the incidence of DVT in MICU patients is approximately 30%. Thromboprophylaxis significantly decreased the rate of DVT by more than 50% to approximately 11%-15%. The prevalence of asymptomatic proximal DVT on admission to MICU is 2%-3%. The incidence of objectively documented DVT in MICU patients receiving thromboprophylaxis varied from 10%-33%, while the incidence of proximal DVT varied from 7% to 16%. Most clinical trials examined low dose unfractionated heparin twice daily for DVT prophylaxis while low molecular weight heparin was used in one randomized clinical trial in MICU patients. Several trials included mixed medical and surgical ICU patients. Data regarding the efficacy of mechanical thromboprophylaxis in MICU patients is limited. Doppler ultrasonography is the most commonly used screening method to detect DVT in MICU patients, while the use of venography to detect or confirm DVT is uncommon. Conclusion: There is limited data assessing risk and efficacy of DVT prophylaxis in the MICU. Current pharmacoprophylaxis is effective in reducing the incidence of DVT in MICU patients although these events continue to occur in patients receiving prophylaxis. Further randomized, blinded studies to assess VTE risk and most effective prophylactic regimen are needed.