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VOLUME 26 , ISSUE S2 ( October, 2022 ) > List of Articles

GUIDELINES

Indian Society of Critical Care Medicine Consensus Statement for Prevention of Venous Thromboembolism in the Critical Care Unit

Bharat G Jagiasi, Akshaykumar A Chhallani, Rishi Kumar, Rahul A Pandit

Keywords : Acute pulmonary embolism, Deep vein thrombosis, Guidelines, Intensive care unit mortality

Citation Information :

DOI: 10.5005/jp-journals-10071-24195

License: CC BY-NC 4.0

Published Online: 31-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Deep vein thrombosis (DVT) is a preventable complication of critical illness, and this guideline aims to convey a pragmatic approach to the problem. Guidelines have multiplied over the last decade, and their utility has become increasingly conflicted as the reader interprets all suggestions or recommendations as something that must be followed. The nuances of grade of recommendation vs level of evidence are often ignored, and the difference between a “we suggest” vs a “we recommend” is overlooked. There is a general unease among clinicians that failure to follow the guidelines translates to poor medical practice and legal culpability. We attempt to overcome these limitations by highlighting ambiguity when it occurs and refraining from dogmatic recommendations in the absence of robust evidence. Readers and practitioners may find the lack of specific recommendations unsatisfactory, but we believe that true ambiguity is better than inaccurate certainty. We have attempted to comply with the guidelines on how to create guidelines.1 And to overcome the poor compliance with these guidelines.2 Some observers have expressed concern that DVT prophylaxis guidelines may cause more harm than good.3 We have placed greater emphasis on large randomized controlled trials (RCTs) with clinical end point and de-emphasized RCTs with surrogate end points and also de-emphasized hypothesis generating studies (observational studies, small RCTs, and meta-analysis of these studies). We have de-emphasized RCTs in non-intensive care unit populations like postoperative patients or those with cancer and stroke. We have also considered resource limitation settings and have avoided recommending costly and poorly proven therapeutic options.


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  1. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. Washington (DC): National Academies Press (US); 2011. DOI: 10.17226/13058.
  2. Kung J, Miller RR, Mackowiak PA. Failure of clinical practice guidelines to meet institute of medicine standards: Two more decades of little, if any, progress. Arch Intern Med 2012;172(21):1628–1633. DOI: 10.1001/2013.jamainternmed.56.
  3. Heit JA. Venous thromboembolism epidemiology: implications for prevention and management. Semin Thromb Hemost 2002;28 (Suppl. 2):3–13. DOI: 10.1055/s-2002-32312.
  4. Ho KM, Chavan S, Pilcher D. Omission of early thromboprophylaxis and mortality in critically ill patients: a multicenter registry study. Chest 2011;140(6):1436–1446. DOI: 10.1378/chest.11-1444.
  5. García-Olivares P, Guerrero JE, Galdos P, Carriedo D, Murillo F, Rivera A. PROF-ETEV study: prophylaxis of venous thromboembolic disease in critical care units in Spain. Intensive Care Med 2014;40(11):1698–1708. DOI: 10.1007/s00134-014-3442-1.
  6. Obi AT, Pannucci CJ, Nackashi A, Abdullah N, Alvarez R, Bahl V, et al. Validation of the caprini venous thromboembolism risk assessment model in critically ill surgical patients. JAMA Surg 2015;150(10): 941–948. DOI: 10.1001/jamasurg.2015.1841.
  7. Xu JX, Dong J, Ren H, Chen XJ, Yang Y, Chen RX, et al. Incidence and risk assessment of venous thromboembolism in cancer patients admitted to intensive care unit for postoperative care. J BUON 2018;23(1):248–254. PMID: 29745099.
  8. Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010;8(11):2450–2457. DOI: 10.1111/j. 1538-7836.2010.04044.x.
  9. Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006;144(3):165–171. DOI: 10.7326/0003-4819-144-3-200602070-00004.
  10. Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc 2014;3(6):e001152. DOI: 10.1161/JAHA.114.001152.
  11. Cook D, Crowther M, Meade M, Rabbat C, Griffith L, Schiff D, et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med 2005;33(7): 1565–1571. DOI: 10.1097/01.ccm.0000171207.95319.b2.
  12. Kaplan D, Casper TC, Elliott CG, Men S, Pendleton RC, Kraiss LW, et al. VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock. Chest 2015;148(5):1224–1230. DOI: 10.1378/chest. 15-0287.
  13. Ramakrishnan N, Detect-Dvt Investigators. Prophylaxis and incidence of symptomatic deep vein thrombosis in Indian patients with sepsis: DETECT-Deep Vein Thrombosis Registry. Indian J Crit Care Med 2017;21(11):765–771. DOI: 10.4103/ijccm.IJCCM_205_17.
  14. Lim W, Meade M, Lauzier F, Zarychanski R, Mehta S, Lamontagne F, et al. Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients. Crit Care Med 2015;43(2): 401–410. DOI: 10.1097/CCM.0000000000000713.
  15. Darzi AJ, Karam SG, Charide R, Etxeandia-Ikobaltzeta I, Cushman M, Gould MK, et al. Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis. Blood 2020;135(20):1788–1810. DOI: 10.1182/blood.2019003603.
  16. Viarasilpa T, Panyavachiraporn N, Marashi SM, Van Harn M, Kowalski RG, Mayer SA. Prediction of symptomatic venous thromboembolism in critically ill patients: the ICU-venous thromboembolism score. Crit Care Med 2020;48(6):e470–e479. DOI: 10.1097/CCM.0000000000004306.
  17. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(Suppl. 2):e227S–e277S. DOI: 10.1378/chest.11-2297.
  18. Gibson CD, Colvin MO, Park MJ, Lai Q, Lin J, Negassa A, et al. Prevalence and predictors of deep vein thrombosis in critically ill medical patients who underwent diagnostic duplex ultrasonography. J Intensive Care Med 2020;35(10):1062–1066. DOI: 10.1177/0885066618813300.
  19. Malato A, Dentali F, Siragusa S, Fabbiano F, Kagoma Y, Boddi M, et al. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus 2015;13(4): 559–568. DOI: 10.2450/2015.0277-14.
  20. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005;51(2–3):70–78. DOI: 10.1016/j.disamonth.2005.02.003.
  21. Kuijer PMM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 1999;159(5):457–460. DOI: 10.1001/archinte.159.5.457.
  22. Ruíz-Giménez N, Suárez C, González R, Nieto JA, Todolí JA, Samperiz AL, et al; RIETE Investigators. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008;100(1):26–31. DOI: 10.1160/TH08-03-0193.
  23. Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, et al. IMPROVE Investigators. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 2011;139(1):69–79. DOI: 10.1378/chest. 09-3081.
  24. Mahan CE, Spyropoulos AC, Fisher MD, Fields LE, Mills RM, Stephenson JJ, et al. Antithrombotic medication use and bleeding risk in medically ill patients after hospitalization. Clin Appl Thromb Hemost 2013;19(5):504–512. DOI: 10.1177/1076029612470967.
  25. Patell R, Gutierrez A, Rybicki L, Khorana AA. Identifying predictors for bleeding in hospitalized cancer patients: a cohort study. Thromb Res 2017;158:38–43. DOI: 10.1016/j.thromres.2017.08.005.
  26. Alhazzani W, Lim W, Jaeschke RZ, Murad MH, Cade J, Cook DJ. Heparin thromboprophylaxis in medical-surgical critically ill patients: a systematic review and meta-analysis of randomized trials. Crit Care Med 2013;41(9):2088–2098. DOI: 10.1097/CCM.0b013e31828cf104.
  27. De A, Roy P, Garg VK, Pandey NK. Low-molecular-weight heparin and unfractionated heparin in prophylaxis against deep vein thrombosis in critically ill patients undergoing major surgery. Blood Coagul Fibrinol 2010;21(1):57–61. DOI: 10.1097/MBC.0b013e3283333505.
  28. PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Cook D, Meade M, Guyatt G, Walter S, Heels-Ansdell D, Warkentin TE, et al. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med 2011;364(14):1305–1314. DOI: 10.1056/NEJMoa1014475.
  29. Li G, Cook DJ, Levine MAH, Guyatt G, Crowther M, Heels-Ansdell D, et al. Competing risk analysis for evaluation of dalteparin versus unfractionated heparin for venous thromboembolism in medical-surgical critically ill patients. Medicine 2015;94(36):e1479. DOI: 10.1097/MD.0000000000001479.
  30. Beitland S, Sandven I, Kjærvik LK, Sandset PM, Sunde K, Eken T. Thromboprophylaxis with low molecular weight heparin versus unfractionated heparin in intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive care medicine 2015;41(7):1209–1219. DOI: 10.1007/s00134-015- 3840-z.
  31. Park J, Lee JM, Lee JS, Cho YJ. Pharmacological and mechanical thromboprophylaxis in critically ill patients: a network meta-analysis of 12 trials. J Korean Med Sci 2016;31(11):1828–1837. DOI: 10.3346/jkms.2016.31.11.1828.
  32. McCullough M, Kholdani C, Zamanian RT. Prevention of deep vein thrombosis and pulmonary embolism in high-risk medical patients. Clin Chest Med 2018;39(3):483–492. DOI: 10.1016/j.ccm.2018.04.002.
  33. Goldhaber SZ, Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011;365(23):2167–2177. DOI: 10.1056/NEJMoa1110899.
  34. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 2013;368(6):513–523. DOI: 10.1056/NEJMoa1111096.
  35. Cohen AT, Harrington RA, Goldhaber SZ, Hull RD, Wiens BL, Gold A, et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 2016;375(6):534–544. DOI: 10.1056/NEJMoa1601747.
  36. Rali P, Gangemi A, Moores A, Mohrien K, Moores L. Direct-acting oral anticoagulants in critically ill patients. Chest 2019;156(3):604–618. DOI: 10.1016/j.chest.2019.05.025.
  37. Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2018;11(11):CD001484. DOI: 10.1002/14651858.CD001484.pub4.
  38. Arabi YM, Khedr M, Dara SI, Dhar GS, Bhat SA, Tamim HM, et al. Use of intermittent pneumatic compression and not graduated compression stockings is associated with lower incident VTE in critically ill patients: a multiple propensity scores adjusted analysis. Chest 2013;144(1):152–159. DOI: 10.1378/chest.12-2028.
  39. Wang Y, Huang D, Wang M, Liang Z, et al. Can intermittent pneumatic compression reduce the incidence of venous thrombosis in critically ill patients: a systematic review and meta-analysis. Clin Appl Thromb Hemost 2020;26:1076029620913942. DOI: 10.1177/1076029620913942.
  40. Hobson DB, Chang TY, Aboagye JK, Lau BD, Shihab HM, Fisher B, et al. Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units. J Crit Care 2017;40:1–6. DOI: 10.1016/j.jcrc.2017.02.016.
  41. Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby G, Reddy DJ, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev 2016;9(9):CD005258. DOI: 10.1002/14651858.CD005258.pub3.
  42. Arabi YM, Al-Hameed F, Burns KEA, Mehta S, Alsolamy SJ, Alshahrani MS, et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. New Engl J Med 2019;380(14):1305–1315. DOI: 10.1056/NEJMoa1816150.
  43. Neumann I, Izcovich A, Zhang Y, Rada G, Kahn SR, Spencer F, et al. DOACs vs LMWHs in hospitalized medical patients: a systematic review and meta-analysis that informed 2018 ASH guidelines. Blood Adv 2020;4(7):1512–1517. DOI: 10.1182/bloodadvances.2019000840.
  44. Lau BD, Murphy P, Nastasi AJ, Seal S, Kraus PS, Hobson DB, et al. Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: a systematic review. CMAJ Open 2020;8(4):E832–E843. DOI: 10.9778/cmajo.20200003.
  45. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risqued'EmboliePulmonaire par Interruption Cave Study Group. N Engl J Med 1998;338(7):409–415. DOI: 10.1056/NEJM199802123380701.
  46. Wehrenberg-Klee E, Stavropoulos SW. Inferior vena cava filters for primary prophylaxis: when are they indicated? Semin Intervent Radiol 2012;29(1):29–35. DOI: 10.1055/s-0032-1302449.
  47. Turner TE, Saeed MJ, Novak E, Brown DL. Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality. JAMA Netw Open 2018;1(3):e180452. DOI: 10.1001/jamanetworkopen.2018.0452.
  48. Sarosiek S, Crowther M, Sloan JM. Indications, complications, and management of inferior vena cava filters: the experience in 952 patients at an academic hospital with a level I trauma center. JAMA Intern Med 2013;173(7):513–517. DOI: 10.1001/jamainternmed.2013.343.
  49. Liu Z, Tao X, Chen Y, Fan Z, Li Y. Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis. PLoS One. 2015;10(4):e0121388. DOI: 10.1371/journal.pone.0121388.
  50. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(Suppl. 2):e419S–e496S. DOI: 10.1378/chest.11-2301. [Erratum in: Chest 2012;142(6):1698–1704.]
  51. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al; French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. Journal of the American Medical Association 2001;286(6):700–707. DOI: 10.1001/jama.286.6.700.
  52. Malinoski D, Ewing T, Bhakta A, Schutz R, Imayanagita B, Casas T, et al. Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis: a prospective analysis of 2,128 catheter days in the surgical intensive care unit. J Trauma Acute Care Surg 2013;74(2):454–460; discussion 461–462. DOI: 10.1097/TA.0b013e31827a0b2f.
  53. Hrdy O, Strazevska E, Suk P, Vach R, Karlik R, Jarkovsky J, et al. Central venous catheter-related thrombosis in intensive care patients-incidence and risk factors: a prospective observational study. Biomed Pap Med FacUnivPalacky Olomouc Czech Repub 2017;161(4):369–373. DOI: 10.5507/bp.2017.034.
  54. Trottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med 1995;23(1):52–59. DOI: 10.1097/00003246-199501000-00011.
  55. Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012;2012(3):CD004084. DOI: 10.1002/14651858.CD004084.pub3.
  56. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular complications of central venous catheterization by insertion site. New Engl J Med 2015;373(13):1220–1229. DOI: 10.1056/NEJMoa1500964.
  57. De Cicco M, Matovic M, Balestreri L, Panarello G, Fantin D, Morassut S, et al. Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res 1997;86(2):101–113. DOI: 10.1016/s0049-3848(97)00054-6.
  58. Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH. Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev 2013;(3):CD008303. DOI: 10.1002/14651858.CD008303.pub2.
  59. Gunning AC, Maier RV, de Rooij D, Leenen LPH, Hietbrink F. Venous thromboembolism (VTE) prophylaxis in severely injured patients: an international comparative assessment. Eur J Trauma Emerg Surg 2019. DOI: 10.1007/s00068-019-01208-z.
  60. Spinal Cord Injury Thromboprophylaxis Investigators. Prevention of venous thromboembolism in the acute treatment phase after spinal cord injury: a randomized, multicenter trial comparing low-dose heparin plus intermittent pneumatic compression with enoxaparin. J Trauma 2003;54(6):1116–1124; discussion 1125–1126. DOI: 10.1097/01.TA.0000066385.10596.71.
  61. Chiou-Tan FY, Garza H, Chan KT, Parsons KC, Donovan WH, Robertson CS, et al. Comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patients with spinal cord injury. Am J Phys Med Rehabil 2003;82(9):678–685. DOI: 10.1097/01.phm.0000083671.27501.47.
  62. Halim TA, Chhabra HS, Arora M, Kumar S. Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective. Spinal Cord 2014;52(7):547–550. DOI: 10.1038/sc.2014.71.
  63. DiGiorgio AM, Tsolinas R, Alazzeh M, Haefeli J, Talbott JF, Ferguson AR, et al. Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data. Neurosurg Focus 2017;43(5):E21. DOI: 10.3171/2017.8.focus17437.
  64. Margolick J, Dandurand C, Duncan K, Chen W, Evans DC, Sekhon MS, et al. A systematic review of the risks and benefits of venous thromboembolism prophylaxis in traumatic brain injury. Can J Neurol Sci 2018;45(4):432–444. DOI: 10.1017/cjn.2017.275.
  65. Farooqui A, Hiser B, Barnes SL, Litofsky NS. Safety and efficacy of early thromboembolism chemoprophylaxis after intracranial hemorrhage from traumatic brain injury. J Neurosurg 2013;119(6):1576–1582. DOI: 10.3171/2013.8.JNS13424.
  66. Ho KM, Rao S, Honeybul S, Zellweger R, Wibrow B, Lipman J, et al. A multicenter trial of vena cava filters in severely injured patients. N Engl J Med. 2019;381(4):328–337. DOI: 10.1056/NEJMoa1806515.
  67. Ho KM, Holley A, Lipman J. Vena Cava filters in severely-injured patients: one size does not fit all. Anaesth Crit Care Pain Med 2019;38(4):305–307. DOI: 10.1016/j.accpm.2019.07.003.
  68. Ho KM, Bham E, Pavey W. Incidence of venous thromboembolism and benefits and risks of thromboprophylaxis after cardiac surgery: a systematic review and meta-analysis. J Am Heart Assoc 2015;4(10):e002652. DOI: 10.1161/JAHA.115.002652.
  69. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Journal of the American Medical Association 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  70. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580–637. DOI: 10.1097/CCM.0b013e31827e83af.
  71. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al; International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine; European Respiratory Society; International Sepsis Forum; Japanese Association for Acute Medicine; Japanese Society of Intensive Care Medicine; Society of Critical Care Medicine; Society of Hospital Medicine; Surgical Infection Society; World Federation of Societies of Intensive and Critical Care Medicine. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36(1):296–327. DOI: 10.1097/01.CCM.0000298158.12101.41 [Erratum in: Crit Care Med 2008;36(4):1394–1396].
  72. Hanify JM, Dupree LH, Johnson DW, Ferreira JA. Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis. J Crit Care 2017;37:206–210. DOI: 10.1016/j.jcrc.2016.10.002.
  73. Levi M, Levy M, Williams MD, Douglas I, Artigas A, Antonelli M, et al. Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated). Am J Respir Crit Care Med 2007;176(5):483–490. DOI: 10.1164/rccm.200612-1803OC.
  74. Cook DJ, Douketis J, Arnold D, Crowther MA. Bleeding and venous thromboembolism in the critically ill with emphasis on patients with renal insufficiency. Curr Opin Pulmonary Med 2009;15(5):455–462. DOI: 10.1097/mcp.0b013e32832ea4.
  75. Weitz JI. Low-molecular-weight heparins. N Engl J Med 1997;337: 688–698. DOI: 10.1056/NEJM199709043371007.
  76. DeBiase C, Giuliano CA, Doshi M, Ganoff M, Alexander Paxton R. Enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in renally impaired ICU patients. Pharmacotherapy 2021;41(5):424–429. DOI: 10.1002/phar.2518.
  77. Rabbat CG, Cook DJ, Crowther MA, McDonald E, Clarke F, Meade MO, et al. Dalteparin thromboprophylaxis for critically ill medical-surgical patients with renal insufficiency. J Crit Care 2005;20:357–363. DOI: 10.1016/j.jcrc.2005.09.009.
  78. Cook D, Douketis J, Meade M, Guyatt G, Zytaruk N, Granton J, et al. Venous thromboembolism and bleeding in critically ill patients with severe renal insufficiency receiving dalteparin thromboprophylaxis: prevalence, incidence and risk factors. Crit Care 2008;12:R32. DOI: 10.1186/cc6810.
  79. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. 8th ed. Chest 2008;133(Suppl. 6):381S–453S. DOI: 10.1378/chest.08-0656.
  80. Kamphuisen PW, Giancarlo A. What is the optimal pharmacological prophylaxis for the prevention of deep-vein thrombosis and pulmonary embolism in patients with acute ischemic stroke? Thromb Res 2007;119(3):265–274. DOI: 10.1016/j.thromres.2006.03.010.
  81. Kamphuisen PW, Agnelli G, Sebastianelli M. Prevention of venous thromboembolism after acute ischemic stroke. J Thromb Haemost 2005;3(6):1187–1194. DOI: 10.1111/j.1538-7836.2005.01443.x.
  82. Vergouwen MD, Roos YB, Kamphuisen PW. Venous thromboembolism prophylaxis and treatment in patients with acute stroke and traumatic brain injury. Curr Opin Crit Care 2008;14(2):149–155. DOI: 10.1097/MCC.0b013e3282f57540.
  83. Boeer A, Voth E, Henze T, Prange HW. Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 1991;54(5):466–467. DOI: 10.1136/jnnp.54.5.466.
  84. Agnelli G, Piovella F, Buoncristiani P, Severi P, Pini M, D'Angelo A, et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998;339(2):80–85. DOI: 10.1056/NEJM199807093390204.
  85. Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J ThrombHaemost 2008;6(4):632–637. DOI: 10.1111/j.1538-7836.2008.02921.x.
  86. James A; Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011;118(3):718–729. DOI: 10.1097/AOG.0b013e3182310c4c.
  87. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–203. DOI: 10.1111/j.1471-0528.2010.02847.x. [Erratum in: BJOG 2015;122(5):e1].
  88. Lockwood C, Wendel G; Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 124: inherited thrombophilias in pregnancy. Obstet Gynecol 2011;118(3):730–740. DOI: 10.1097/AOG.0b013e3182310c6f.
  89. Croles FN, Nasserinejad K, Duvekot JJ, Kruip MJ, Meijer K, Leebeek FW. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and Bayesian meta-analysis. British Medical Association 2017;359:j4452. DOI: 10.1136/bmj.j4452.
  90. Jacobson BF, Virendra R, Dara P, Sayre T. Safety and efficacy of enoxaparin in pregnancy: a systematic review and meta-analysis. Adv Ther 2020;37(1):27–40. DOI: 10.1007/s12325-019- 01124-z.
  91. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106(2):401–407. DOI: 10.1182/blood-2005-02-0626.
  92. Dutt T, Simcox D, Downey C, McLenaghan D, King C, Gautam M, et al. Thromboprophylaxis in COVID-19: anti-FXa-the missing factor? Am J Respir Crit Care Med 2020;202(3):455–457. DOI: 10.1164/rccm.202005-1654LE.
  93. National Heart, Lung, and Blood Institute NIH ACTIV trial of blood thinners pauses enrollment of critically ill COVID-19 patients. 2020. Available from: https://www.nhlbi.nih.gov/news/2020/nih-activ-trial-blood-thinners-pauses-enrollment-critically-ill-covid-19-patients.
  94. REMAP-CAP Investigators, ACTIV-4a Investigators; ATTACC Investigators, Goligher EC, Bradbury CA, McVerry BJ, Lawler PR, et al. Therapeutic anticoagulation with heparin in critically ill patients with Covid-19. New Engl J Med 2021;385(9):777–789. DOI: 10.1056/NEJMoa2103417.
  95. INSPIRATION Investigators. Sadeghipour P, Talasaz AH. Effect of intermediate-dose vs standard-dose prophylactic anticoagulation on thrombotic events, extracorporeal membrane oxygenation treatment, or mortality among patients with COVID-19 admitted to the intensive care unit: the INSPIRATION randomized clinical trial. Journal of the American Medical Association 2021. DOI: 10.1001/jama.2021.4152.
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