Grade B+ Recommendation Prevention of DVT in critically ill patients
This review may be edited
Author info
Posted By:	A Delaney
E-Mail:	apdelane@doh.health.nsw.gov.au
Posted Date:	30/9/2002
Title:	Prevention of DVT in critically ill patients
PubMed Resource Link:	Click here to repeat the Medline search used to develop this EBR.
Evidence-based Recommendation
Best level of evidence
	Well conducted systematic review, the best individual trials are level II evidence.
Target Population
	General intensive care patients
Purpose
	For medical/surgical ICU patients to reduce the incidence of DVT from 28-31% to 11-15%, with pharmacological prophylaxis. In patients considered at high risk for bleeding (eg neurosurgical patients), mechanical devices such as graded compression stockings and/or intermittant pneumatic compression devices, when compared to no prophylaxis reduce the incidence of DVT by approximately 57% (OR 0.28;95%CI,0.17-0.46)
Exclusion criteria
	Almost all intensive care patients should have some form of DVT prophylaxis
Recommendation
	All Intensive care patients should have some form of prophylaxis for DVT. 1.Patients at lower risk from bleeding should have heparin 5000 units sc bid. 2. In patients at a higher risk from bleeding (eg; intracranial pathology, recent major haemorrhage...) mechanical means of prevention such as intermittant compression devices and graded compression stockings should be used and heparin 5000 units sci bd commenced as soon as the risk of bleeding has decreased. 3. In patients at a very high risk of DVT (eg; major trauma, spinal cord injury, major surgery for cancer...) consideration should be given to using LMWH 4000 to 6000 anti factor Xa units daily.
Potential harm
	Bleeding rates were reported in only one of the trials and occured in 6(5.6%) of the patients treated with a LMWH (nadroparin) compared to 3(2.7%) in the control group (not significantly different p=0.28). There is insufficient data in these studies to determine the incidence and importance of other potential harms such as thrompbocytopaenia or HITTS.
Development Information
Date EBR last updated
	23/9/2002
Literature source and search terms
	Medline was searced using PUBMED from 1966 to 23 September 2002 using the following terms: prevention AND ("venous thrombosis" OR venous thromboembolism OR "venous thromboembolism" OR venous thrombosis OR pulmonary embolism OR deep vein thrombosis) AND (critical* OR intensive* OR intensive care OR intensive care units OR "intensive therapy" OR critically ill OR critical illness OR critical care) AND (random* OR "systematic review*" OR meta-analysis OR guidelines OR randomized controlled trials OR randomized controlled trial OR systematic [sb])
Study selection
	All 91 abstracts were hand searched for relevance. 2 recent systematic reviews were identified as was one primary study.
References
	Geerts W, Cook D, Selby R, Etchells E. Venous Thromboembolism and It's Prevention in Critical Care. Journal of Critical Care 2002;17:95-104. (Level II+ ) Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep Vein THrombosis and It's Prevention in Critically Ill Adults. Arch Int Med 2001;161:1268-1279 (Level II+ ) Fraisse F, Holapfel L, Coulaud J-M, et al. Nadroparin in the Prevention of Deep Vein Thrombosis in Acute Decompensated COPD. Am J Resp Crit Care Med 2000;161:1109-1114.
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