In this episode, I’ll discuss the risk factors associated with the development of venous thromboembolism in ICU patients.
A recent review and systematic analysis published in Critical Care Medicine evaluated 39 observational cohort studies involving over 700,000 patients to identify what risk factors were associated with the development of VTE in critically ill patients.
There were 5 patient-specific factors and 5 ICU-specific factors that were found to be associated with an increased odds of VTE development.
The 5 patient-specific risk factors were:
1. Older age (1.15 odds ratio for every decade)
2. Obesity (1.25 odds ratio)
3. Active malignancy (1.7 odds ratio)
4. History of VTE (4.77 odds ratio)
5. History of recent surgery (1.77 odds ratio)
The 5 ICU-specific risk factors were:
1. Sepsis (1.41 odds ratio)
2. Lack of pharmacologic VTE prophylaxis (1.8 odds ratio)
3. Central venous catheter (2.93 odds ratio)
4. Invasive mechanical ventilation (1.74 odds ratio)
5. Use of vasoactive medication (1.86 odds ratio)
Each of these risk factors was judged to be associated with high or moderate certainty of increased odds of VTE development.
This study can be used to develop a VTE risk stratification tool for ICU patients, but it also identifies some potentially modifiable risk factors that a pharmacist may be able to address. The most obvious of these is the lack of pharmacologic VTE prophylaxis. Presuming that some patients who lack pharmacologic VTE prophylaxis do so because of an oversight rather than a contraindication, an ICU pharmacist can eliminate this risk factor by recommending prophylaxis in appropriate patients. Likewise, efforts to reduce the duration of mechanical ventilation, vasopressors, and central venous catheters may be indirectly modifiable by pharmacist interventions.
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