PMID- 24766968 OWN - NLM STAT- MEDLINE DCOM- 20150417 LR - 20220311 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 18 IP - 2 DP - 2014 Apr 25 TI - Thromboprophylaxis patterns and determinants in critically ill patients: a multicenter audit. PG - R82 LID - 10.1186/cc13844 [doi] AB - INTRODUCTION: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk. METHODS: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH. RESULTS: We enrolled 1,935 patients (62.3 +/- 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 +/- 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23). CONCLUSIONS: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target. FAU - Lauzier, Francois AU - Lauzier F FAU - Muscedere, John AU - Muscedere J FAU - Deland, Eric AU - Deland E FAU - Kutsogiannis, Demetrios Jim AU - Kutsogiannis DJ FAU - Jacka, Michael AU - Jacka M FAU - Heels-Ansdell, Diane AU - Heels-Ansdell D FAU - Crowther, Mark AU - Crowther M FAU - Cartin-Ceba, Rodrigo AU - Cartin-Ceba R FAU - Cox, Michael J AU - Cox MJ FAU - Zytaruk, Nicole AU - Zytaruk N FAU - Foster, Denise AU - Foster D FAU - Sinuff, Tasnim AU - Sinuff T FAU - Clarke, France AU - Clarke F FAU - Thompson, Patrica AU - Thompson P FAU - Hanna, Steven AU - Hanna S FAU - Cook, Deborah AU - Cook D CN - Co-operative Network of Critical Care Knowledge Translation for Thromboprophylaxis (CONECCKT-T) Investigators CN - Canadian Critical Care Trials Group LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20140425 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) SB - IM MH - Aged MH - Anticoagulants/*administration & dosage MH - Cohort Studies MH - Critical Illness/*therapy MH - Female MH - Heparin, Low-Molecular-Weight/*administration & dosage MH - Humans MH - Male MH - Medical Audit/*methods MH - Middle Aged MH - Retrospective Studies MH - Thrombolytic Therapy/*methods PMC - PMC4057024 FIR - Cook, Deborah IR - Cook D FIR - Clarke, France IR - Clarke F FIR - Zytaruk, Nicole IR - Zytaruk N FIR - Hall, Rick IR - Hall R FIR - Julien, Lisa IR - Julien L FIR - St Laurent, Michelle IR - St Laurent M FIR - Meade, Maureen IR - Meade M FIR - Hand, Lori IR - Hand L FIR - Laberge, Ann IR - Laberge A FIR - McIntyre, Lauralyn IR - McIntyre L FIR - Pagliarello, Guiseppe IR - Pagliarello G FIR - Watpool, Irene IR - Watpool I FIR - McArdle, Tracy IR - McArdle T FIR - Van Tol, Allyshia IR - Van Tol A FIR - Zito, Nicole IR - Zito N FIR - Van Beinum, Amanda IR - Van Beinum A FIR - Castellucci, Lana Antoinette IR - Castellucci LA FIR - Reddie, Shawna IR - Reddie S FIR - Skrobik, Yoanna IR - Skrobik Y FIR - Harvey, Johanne IR - Harvey J FIR - Beauregard, Brigitte IR - Beauregard B FIR - Albert, Martin IR - Albert M FIR - Williamson, David IR - Williamson D FIR - Mehta, Sangeeta IR - Mehta S FIR - Brown, Maedean IR - Brown M FIR - Kuint, Rottem IR - Kuint R FIR - Sinuff, Taz IR - Sinuff T FIR - Marinoff, Nicole IR - Marinoff N FIR - Raghunath, Ashwati IR - Raghunath A FIR - Marshall, John IR - Marshall J FIR - Wang, Melissa IR - Wang M FIR - Roy, Pragma IR - Roy P FIR - Faraj, Raphael IR - Faraj R FIR - Muscedere, John IR - Muscedere J FIR - Fleury, Susan IR - Fleury S FIR - Godfrey, Nicole IR - Godfrey N FIR - Griesdale, Donald IR - Griesdale D FIR - Foster, Denise IR - Foster D FIR - Logie, Susan IR - Logie S FIR - Martinka, Greg IR - Martinka G FIR - Foster, Denise IR - Foster D FIR - Dodek, Peter IR - Dodek P FIR - Brewer, Kelsey IR - Brewer K FIR - Shepherd, Sarah IR - Shepherd S FIR - Lellouche, Francois IR - Lellouche F FIR - Ferland, Marie-Claude IR - Ferland MC FIR - Karachi, Tim IR - Karachi T FIR - Clarke, France IR - Clarke F FIR - Zytaruk, Nicole IR - Zytaruk N FIR - Jacka, Michael IR - Jacka M FIR - Irwin, Marleen IR - Irwin M FIR - Gentles, Emily IR - Gentles E FIR - Auld, Fiona IR - Auld F FIR - Atkins, Leslie IR - Atkins L FIR - Lamontagne, Francois IR - Lamontagne F FIR - Langevin, Chantal IR - Langevin C FIR - Paunovic, Bojan IR - Paunovic B FIR - Marten, Nicole IR - Marten N FIR - Eggerton, Shauna IR - Eggerton S FIR - Kutsogiannis, D Jim IR - Kutsogiannis DJ FIR - Thompson, Patrica IR - Thompson P FIR - Jossy, Darlene IR - Jossy D FIR - Kumar, Hari IR - Kumar H FIR - Shea, Patricia IR - Shea P FIR - Roussos, Marios IR - Roussos M FIR - Stoger, Sandra IR - Stoger S FIR - Cryderman, Cindy IR - Cryderman C FIR - Romano, Kathleen IR - Romano K FIR - Carli, Amanda IR - Carli A FIR - Hicklin, Deanna IR - Hicklin D FIR - Cartin-Ceba, Rodrigo IR - Cartin-Ceba R FIR - Meade, Laurie IR - Meade L FIR - Wilson, Gregory IR - Wilson G FIR - Marquez, Alberto IR - Marquez A FIR - O'Brien, Jackie IR - O'Brien J FIR - Krause, Catherine IR - Krause C FIR - Cyton, Margaret IR - Cyton M FIR - Fowler, Kimberly IR - Fowler K FIR - Hubert, Catherine IR - Hubert C FIR - Clarke, France IR - Clarke F FIR - Grainger, Laurel IR - Grainger L FIR - Zytaruk, Nicole IR - Zytaruk N EDAT- 2014/04/29 06:00 MHDA- 2015/04/18 06:00 PMCR- 2014/04/25 CRDT- 2014/04/29 06:00 PHST- 2013/10/18 00:00 [received] PHST- 2014/02/25 00:00 [accepted] PHST- 2014/04/29 06:00 [entrez] PHST- 2014/04/29 06:00 [pubmed] PHST- 2015/04/18 06:00 [medline] PHST- 2014/04/25 00:00 [pmc-release] AID - cc13844 [pii] AID - 10.1186/cc13844 [doi] PST - epublish SO - Crit Care. 2014 Apr 25;18(2):R82. doi: 10.1186/cc13844.