Thromboprophylaxis for Intensive Care Patients.
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Date
2014-01-01
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Abstract
The advent of low-molecular-weight heparin (LMWH) marked a new chapter in the
prevention of venous thromboembolism. The enviable pharmacokinetic properties
associated with this class of medication, ensured the place of LMWH as an attractive, if
albeit more expensive alternative to unfractionated heparin. Predictable and reproducible
dose response continues to negate the need for monitoring in most patient groups, while
the availability of antidotes further boosts the safety profile of LMWH. These agents have
long proven their worth in the medico-surgical patient population. However we have
recently shown in randomised studies, that LMWH at the current recommended dose
may not be as effective for critically ill patients. Critically ill patients encompass that
population of patients with profound disturbance of physiology, who are at imminent risk
of death and in need of continuous care. Such patients have proven to be somewhat
resistant, and current evidence indicates that they may benefit from a higher dose of
LMWH. A difficult undertaking, considering the heterogeneity of this population, as well
as their predisposition to both haemorrhage and thromboembolism. A variety of new oral
antithrombotics has recently become available for use among certain patient
populations, but has not yet been studied in the intensive care unit (ICU) setting. These
agents have been associated with increased risk of bleeding, and as yet, a definitive
strategy in the event of major bleeding does not exist. In addition, they are more costly
when compared with LMWH. All the aforementioned factors combine to make the new
oral agents, unattractive alternatives for thromboprophylaxis in the ICU population.
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Keywords
Heparin, intensive care, thromboprophylaxis, venous thromboembolism, lowmolecular- weight heparin, mechanical thromboprophylaxis, rivaroxaban, dabigatran
Citation
Robinson Sian, Toft Palle. Thromboprophylaxis for Intensive Care Patients. British Journal of Medicine and Medical Research. 2014 Jan; 4(1): 46-56.