Critical care clinics
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Venous thromboembolism (VTE) originates in systemic venous thrombosis and has different etiological mechanisms and natural history from arterial thrombosis. VTE typically originates as deep venous thrombosis in a lower extremity, where it may give rise to acute symptoms “upstream” from the obstructed vein, result in pulmonary embolism, and/or cause chronic venous obstruction. Pulmonary embolism may result in acute respiratory symptoms, cardiovascular collapse and, uncommonly, may also cause chronic disease.
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Anticoagulation has been proven to be effective in preventing and treating deep vein thrombosis and pulmonary embolus. However, many critically ill patients are unable to receive anticoagulation or suffer recurrent venous thromboembolism despite adequate treatment. ⋯ Indications for, techniques, and complications of vena cava filter insertion are reviewed. The importance of vena cava filters with the option to be retrieved and bedside insertion in the intensive care unit is emphasized.
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Critical care clinics · Oct 2011
ReviewHeparin-induced thrombocytopenia in critically ill patients.
Critically ill patients commonly evince thrombocytopenia, either evident on admission to the intensive care unit (ICU) or that develops during their stay. Heparin-induced thrombocytopenia (HIT) explains thrombocytopenia in only approximately 1/100 critically ill patients; also, only 1 or 2 in 10 ICU patients with a positive PF4-dependent enzyme immunoassay has “true” HIT. Thus, there is major potential for overdiagnosis of HIT in the ICU. A recent study showing that dalteparin is associated with a reduced frequency of HIT indicates that critically ill patients too can benefit from the HIT-reducing potential of this low molecular weight heparin preparation.
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Critical care clinics · Oct 2011
ReviewVenous thromboembolism prophylaxis in critically ill patients.
Venous thromboembolism (VTE) is a frequent but often silent complication of critical illness that has a negative impact on patient outcomes. The prevention of VTE is an essential component of patient care in the intensive care unit (ICU) setting, and is the focus of this article. The use of anticoagulant thromboprophylaxis significantly decreases the risk of VTE in ICU patients and is discussed at length.
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Critical care clinics · Oct 2011
ReviewEpidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism.
The proportion of hospitalized patients with pulmonary embolism (PE) is increasing. Whether this represents more admissions with PE or more diagnoses made in hospitalized patients is uncertain. The proportion of hospitalized patients with deep venous thrombosis has decreased precipitously as a result of home treatment. ⋯ The incidence of PE increases exponentially with age, but no age group, including infants and children, is immune. Several medical illnesses have now been shown to be associated with a higher risk for venous thromboembolism. Epidemiologic data and new information on risk factors provide insight into making an informed clinical assessment and evaluation for antithrombotic prophylaxis.