• Madhukar S Patel, Tyler Ewing, Allen Kong, David Nguyen, Cecilia Lau, Cristobal Barrios, Marianne Cinat, Matthew Dolich, Michael Lekawa, and Darren Malinoski.
• Department of Surgery, Massachusetts General Hospital, Boston, USA.
• Am. J. Surg. 2013 Sep 1; 206 (3): 300-6.

BackgroundWe sought to identify independent predictors of venous thromboembolism in critically ill general surgery patients who cannot receive chemical prophylaxis in order to identify those who may benefit from aggressive screening and/or prophylactic inferior vena cava filter placement.MethodsNontrauma patients in the surgical intensive care unit were prospectively followed for 2 years. Patients who had contraindications to prophylactic anticoagulation and received routine screening duplex examinations were included. Data regarding lower-extremity deep venous thrombosis or pulmonary embolism (PE) rates, past medical history (PMH), surgeries, and transfusions were collected. Logistic regression was used to identify independent predictors of lower-extremity deep venous thrombosis or PE (venous thromboembolism) with a P < .05.ResultsData were complete for 204 patients. Twenty (9.8%) patients developed venous thromboembolism. Independent predictors of venous thromboembolism included postoperative blood product requirements (odds ratio = 1.04 per unit), a PMH of PE (OR = 10.1), and a PMH of renal insufficiency (odds ratio = 5.1).ConclusionsAggressive screening and/or prophylactic inferior vena cava filter may be considered when prophylactic anticoagulation is prohibited in patients with increased postoperative transfusion requirements or a PMH of either PE or renal insufficiency.Copyright © 2013 Elsevier Inc. All rights reserved.

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