PMID- 11251346
OWN - NLM
STAT- MEDLINE
DCOM- 20010705
LR  - 20171101
IS  - 0301-0147 (Print)
IS  - 0301-0147 (Linking)
VI  - 30 Suppl 2
DP  - 2000
TI  - Risk assessment and prophylaxis of venous thromboembolism in acutely and/or 
      critically ill patients.
PG  - 77-81; discussion 63
AB  - Both undetected and clinically evident venous thrombosis and venous 
      thromboembolism (VTE) can seriously impact the prognosis of acutely and/or 
      critically ill patients. Pulmonary embolism (PE) is harder to diagnose in the 
      acutely and/or critically ill, many of whom also have developed respiratory 
      failure for other reasons. Deep vein thrombosis (DVT) of the upper and lower 
      extremities can subsequently complicate insertion of central venous catheters, 
      leading to PE, sepsis and septic shock. Recovery from the original critical 
      illness (e.g. weaning from mechanical ventilation) can be adversely affected by 
      these complications. There are recent data suggesting that, for prophylaxis, 
      low-molecular-weight heparin (LMWH) is more effective than unfractionated heparin 
      (UFH) in critically ill trauma patients, and that high-dose LMWH is more 
      effective than placebo or low-dose LMWH in seriously ill medical patients. In 
      both populations, LMWH appeared safe. While LMWH appears superior to UFH in acute 
      stroke patients to prevent venographically-proven lower-extremity DVT, whether it 
      provides a superior long-term outcome after acute stroke is uncertain. One study 
      found that a high dosage of the LMWH dalteparin was more effective than placebo 
      in preventing left ventricular thrombi after acute myocardial infarction, but 
      there was a significant safety cost. Current questions surrounding prophylaxis of 
      VTE and the use of LMWH in acutely and/or critically ill patients include whether 
      monitoring levels and dosage adjustment in some of these patients would improve 
      outcome, and whether the diagnosis of VTE can be improved so that treatment can 
      be instituted when prophylaxis has failed.
CI  - Copyright 2001 S. Karger AG, Basel
FAU - Davidson, B L
AU  - Davidson BL
AD  - Pulmonary and Critical Care Medicine, Virginia Mason Medical Center, Seattle, WA 
      98101, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - Switzerland
TA  - Haemostasis
JT  - Haemostasis
JID - 0371574
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Critical Illness
MH  - Disease Susceptibility
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Incidence
MH  - Pulmonary Embolism/epidemiology/prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Risk Factors
MH  - Safety
MH  - Thromboembolism/epidemiology/prevention & control
MH  - Thrombophlebitis/epidemiology/prevention & control
MH  - Venous Thrombosis/epidemiology/*prevention & control
RF  - 23
EDAT- 2001/03/17 10:00
MHDA- 2001/07/06 10:01
CRDT- 2001/03/17 10:00
PHST- 2001/03/17 10:00 [pubmed]
PHST- 2001/07/06 10:01 [medline]
PHST- 2001/03/17 10:00 [entrez]
AID - 54168 [pii]
AID - 10.1159/000054168 [doi]
PST - ppublish
SO  - Haemostasis. 2000;30 Suppl 2:77-81; discussion 63. doi: 10.1159/000054168.