It is obvious that patients in ICU are prone to develop Deep Vein Thrombosis since they are confined to the bed and also due to their clinical conditions, hence DVT prophylaxis is essential in ICU patient care.
PATIENTS AT RISK:
Medical patients:
Mobility significantly reduced ≥ 3 days
Reduced mobility + any VTE risk
Surgical patients:
Anaesthetic time > 90 minutes
Anaesthetic time > 60 minutes + operation involves pelvis or lower limb
Acute surgical admission with inflammatory or intra-abdominal
Expected reduced mobility
RISK FACTORS:
Active cancer or cancer treatment
Age > 60 years
Intensive care admission
Dehydration
Known thrombophilia
BMI > 30
1 or more significant medical comorbidity
Personal or family history of VTE
Use of HRT or contraceptive
Varicose veins with phlebitis
There are two varieties of Thromboprophylaxis.
PRIMARY: To prevent the incidence of DVT
Unfractionated Heparin (UFH)
Low Molecular Weight Heparin (LMWH)
Fondaparinux
Pneumatic and graduated compression stokings
SECONDARY: Early detection and management of DVT
It is less commonly used
LMWH DVT PROHYLAXIS:.
Enoxaparin 20 mg Q12H preop
Enoxaparin 40 mg daily for at least 4 days post-op
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