PMID- 34419428
OWN - NLM
STAT- MEDLINE
DCOM- 20220309
LR  - 20220309
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 161
IP  - 2
DP  - 2022 Feb
TI  - VTE Prophylaxis in Critically Ill Adults: A Systematic Review and Network 
      Meta-analysis.
PG  - 418-428
LID - S0012-3692(21)03688-6 [pii]
LID - 10.1016/j.chest.2021.08.050 [doi]
AB  - BACKGROUND: Critically ill adults are at increased risk of VTE, including DVT, 
      and pulmonary embolism. Various agents exist for venous thromboprophylaxis in 
      this population. RESEARCH QUESTION: What is the comparative efficacy and safety 
      of prophylaxis agents for prevention of VTE in critically ill adults? STUDY 
      DESIGN AND METHODS: Systematic review and network meta-analysis of randomized 
      clinical trials (RCTs) evaluating efficacy of thromboprophylaxis agents among 
      critically ill patients. We searched six databases (including PubMed, EMBASE, and 
      Medline) from inception through January 2021 for RCTs of patients in the ICU 
      receiving pharmacologic, mechanical, or combination therapy (pharmacologic agents 
      and mechanical devices) for thromboprophylaxis. Two reviewers performed 
      screening, full-text review, and extraction. We used the Grading of 
      Recommendations Assessment, Development, and Evaluation to rate certainty of 
      effect estimates. RESULTS: We included 13 RCTs (9,619 patients). Compared with 
      control treatment (a composite of no prophylaxis, placebo, or compression 
      stockings only), low-molecular-weight heparin (LMWH) reduced the incidence of DVT 
      (OR, 0.59 [95% credible interval [CrI], 0.33-0.90]; high certainty) and 
      unfractionated heparin (UFH) may reduce the incidence of DVT (OR, 0.82 [95% CrI, 
      0.47-1.37]; low certainty). LMWH probably reduces DVT compared with UFH (OR, 0.72 
      [95% CrI, 0.46-0.98]; moderate certainty). Compressive devices may reduce risk of 
      DVT compared with control treatments; however, this is based on low-certainty 
      evidence (OR, 0.85 [95% CrI, 0.50-1.50]). Combination therapy showed unclear 
      effect on DVT compared with either therapy alone (very low certainty). 
      INTERPRETATION: Among critically ill adults, compared with control treatment, 
      LMWH reduces incidence of DVT, whereas UFH and mechanical compressive devices may 
      reduce the risk of DVT. LMWH is probably more effective than UFH in reducing 
      incidence of DVT and should be considered the primary pharmacologic agent for 
      thromboprophylaxis. The efficacy and safety of combination pharmacologic therapy 
      and mechanical compressive devices were unclear. TRIAL REGISTRY: Open Science 
      Framework; URL: https://osf.io/694aj.
CI  - Copyright (c) 2021 American College of Chest Physicians. Published by Elsevier Inc. 
      All rights reserved.
FAU - Fernando, Shannon M
AU  - Fernando SM
AD  - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, 
      Canada. Electronic address: sfernando@qmed.ca.
FAU - Tran, Alexandre
AU  - Tran A
AD  - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
FAU - Cheng, Wei
AU  - Cheng W
AD  - Department of Biostatistics, Yale School of Public Health, Yale University, New 
      Haven, CT.
FAU - Sadeghirad, Behnam
AU  - Sadeghirad B
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, 
      ON, Canada.
FAU - Arabi, Yaseen M
AU  - Arabi YM
AD  - Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi 
      Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health 
      Sciences, Riyadh, Kingdom of Saudi Arabia.
FAU - Cook, Deborah J
AU  - Cook DJ
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, 
      Canada.
FAU - Moller, Morten Hylander
AU  - Moller MH
AD  - Department of Intensive Care, Copenhagen University Hospital Righospitalet, 
      Copenhagen, Denmark.
FAU - Mehta, Sangeeta
AU  - Mehta S
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, 
      Canada.
FAU - Fowler, Robert A
AU  - Fowler RA
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla 
      Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 
      Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, 
      ON, Canada.
FAU - Burns, Karen E A
AU  - Burns KEA
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, ON, Canada; Interdepartmental Division of Critical Care Medicine, 
      University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical 
      Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, 
      Canada.
FAU - Wells, Philip S
AU  - Wells PS
AD  - Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, 
      Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, 
      ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 
      Ottawa, ON, Canada.
FAU - Carrier, Marc
AU  - Carrier M
AD  - Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, 
      Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, 
      ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 
      Ottawa, ON, Canada.
FAU - Crowther, Mark A
AU  - Crowther MA
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, 
      Canada.
FAU - Scales, Damon C
AU  - Scales DC
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla 
      Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 
      Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, 
      ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge 
      Institute, St. Michael's Hospital, Toronto, ON, Canada.
FAU - English, Shane W
AU  - English SW
AD  - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada; School of Epidemiology and Public Health, University of Ottawa, 
      Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research 
      Institute, Ottawa, ON, Canada.
FAU - Kyeremanteng, Kwadwo
AU  - Kyeremanteng K
AD  - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 
      Ottawa, ON, Canada.
FAU - Kanji, Salmaan
AU  - Kanji S
AD  - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 
      Ottawa, ON, Canada.
FAU - Kho, Michelle E
AU  - Kho ME
AD  - School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
FAU - Rochwerg, Bram
AU  - Rochwerg B
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, 
      Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210819
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Chest. 2022 Feb;161(2):305-306. PMID: 35131051
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - *Critical Illness
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - *Intermittent Pneumatic Compression Devices
MH  - Pulmonary Embolism/prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/*prevention & control
OTO - NOTNLM
OT  - DVT
OT  - VTE
OT  - critical care medicine
OT  - pulmonary embolism
EDAT- 2021/08/23 06:00
MHDA- 2022/03/11 06:00
CRDT- 2021/08/22 20:42
PHST- 2021/04/04 00:00 [received]
PHST- 2021/08/04 00:00 [revised]
PHST- 2021/08/11 00:00 [accepted]
PHST- 2021/08/23 06:00 [pubmed]
PHST- 2022/03/11 06:00 [medline]
PHST- 2021/08/22 20:42 [entrez]
AID - S0012-3692(21)03688-6 [pii]
AID - 10.1016/j.chest.2021.08.050 [doi]
PST - ppublish
SO  - Chest. 2022 Feb;161(2):418-428. doi: 10.1016/j.chest.2021.08.050. Epub 2021 Aug 
      19.