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Abstract
This study was designed to evaluate the policy used for venous thromboembolism prophylaxis in our postoperative lCU.
from 264 patient admissions all over the study period only 92 patients were eligible for the study. The causes of exclusion were either the patient were already receiving therapeutic doses of anticoagulants (115 patients), or short lCU stay less than 3 days (31 patients) or patients got mobile before 3 days (10 patients) or lastly these who can’t be transferred to duplex unit (16 patients).
The study patients were categorized to low, moderate and high risk groups and according received the appropriate prophylaxis.
Screening all study patients using lower extremity ultrasonography, 6 cases out of 92 were recorded to have deep . vein thrombosis (DVT) with an overall incidence 6.5 %.
Actually 26 patients (out of 92) failed to receive prophylaxis either due to contraindications are unavailable or due to missed prophylaxis.
The DVT incidence 111 patients who actually received prophylaxis was 4.5 % (3 cases out of 66 who received prophylaxis). The DVT incidence in patients received no prophylaxis was 11.5 % (3 cases out of 26).
DVT incidence in previously immobilized patients before ICU admission was 14.3 % (lout of 7 patients). This percentage is more than the double of that recorded in other patients who were mobile berore leu ,Ilhllission, which \Vas 5.t) Ii’ll (5 ou! or 85 patients).
The incidencc or IJVT in patil.:nts unllergoing vanous types of surgery or those subjected to trauma in order of decreasing frequency was neurosurgery 15 %, gynecologic and obstetric surgery 12.5 %, general surgery 9.1 %, non surgical patients and was zero % in urosurgery, cardiothroracic surgery, otorhinolaryngeal surgery, and trauma patients.
Comparing the efficacy of different prophylactic measures in the second group of the study (the largest group in number ”54” and patients are at the same risk), it was found that DVT incidence rate was 6.7 % in heparin receiving group (1 case out of 14 cases), zero % in LMWH receiving patients (8 cases). Unfortunately we had only one patient on aspirin, 2 patients used IPe and 6 patients used ES. This small number of patients using those prophylaxis measures makes the resulting zero % DVT incidence can’t be considered a valuable results.
Monitoring the patient on anticoagulant therapy for bleeding complications, 4 cases (out of 27 who received anticoagulants prophylaxis) were recorded to have bleeding.
The percentage of bleeding was 17.6 % with patients receiving low dose unfractionated heparin and zero % with those who received low molecular weight heparin.
Only one patient who received aspirin \vho made us unable to evaluate bleeding as a complication with aspirin prophylaxis.