Venous thromboembolism in a medical intensive care unit. The effect of implementing clinical practice guidelines

OBJECTIVE: To determine the incidence of VTE in medical patients admitted to the intensive care unit (ICU) following the implementation of a standard deep venous thrombosis (DVT) prophylaxis protocol using unfractionated heparin (UFH), and to identify risk factors for DVT in these patients.

METHODS: We prospectively studied 123 consecutive patients admitted to the Medical ICU of King Khalid University Hospital, Riyadh, Saudi Arabia. We excluded patients on anticoagulation or with contraindications for heparin. Patients who were negative for DVT by screening Doppler Ultrasound (U/S) were started on UFH twice a day. The Doppler U/S was repeated twice weekly for 6 weeks.

RESULTS: One hundred and four critically ill medical patients were included. A DVT was diagnosed in 10 patients while receiving UFH, an incidence rate of 9.8%. The compliance rate was 98%. Sepsis (p=0.0167), limited mobility (p<0.0001), previous DVT (p=0.024), and nephrotic syndrome (p=0.008) were significantly more common in patients who developed DVT compared with others. However, by backward logistic regression, previous DVT was the only significant factor for the development of DVT (B=-0.439, AOR=5.01, p<0.0001).

CONCLUSION: The implementation of clinical practice guidelines for VTE prophylaxis in critically ill medical patients using UFH twice daily resulted in a high compliance rate and low incidence of VTE. Previous DVT was a significant risk factor for development of VTE.