Venous thromboembolism prophylaxis usage in critical care units in National Hospital Sri Lanka

Abstract

Background: Venous thromboembolism (VTE) is an important cause of mortality and morbidity in critical care patients. This is as a result of high prevalence of VTE risk factors in this group of patients including physical inactivity, immobilization, vascular injury and / or hypercoagulable state. The effect of these risk factors are cumulative. VTE may progress into thrombophebitis or pulmonary embolism (PE) with increased mortality and morbidity and have enormous economic issues. But the risk of VTE and its prevention have been poorly characterized in this population. Evidence based thromboembolic prophylaxis guidelines are also not widely available for these critically ill patients. The main objectives of this audit were to determine the presence and the type of the risk factors and the prophylaxis given in patients admitted to five adult intensive care units (ICU) in National Hospital Sri Lanka (NHSL). Method: This audit was carried out from 1st to 31st of March 2011 in five critical care units in NHSL. Confidentiality was maintained. Data was obtained with the use of pre formed data collection forms, filled by post graduate trainees in anaesthesiology. Results: There were a total of 90 patients, 53% male and 47% female, and 40% were in the 30-40 year age group. Majority (49%) of the patients were admitted to ICU following surgery. 35 patients (38.9%) had at least 2 risk factors for VTE. 39 patients (43.3%) had received VTE prophylaxis. 51 patients (56.6%) did not get any prophylaxis against VTE. 43.3% were given only pharmacological prophylaxis and 33.3% were offered both pharmacological and mechanical prophylaxis. Enoxaparin 40mg daily was used as the drug of choice in majority of the patients irrespective of their body weight. Pharmacological VTE prophylaxis for the postoperative patients was started 8-12 hours after admission in the majority. Conclusion: We found an under usage of VTE prophylaxis on at risk patients in intensive care units at NHSL. We would like to highlight the importance of having institutional guidelines on VTE prophylaxis and improving the awareness on VTE among the ICU staff.