Why are ICU patients particularly vulnerable to VTE events?

Patients within the ICU typically present with multiple and rapidly changing VTE risk factors. This is in part due to their underlying diagnosis as well as medical interventions which affect mobility, circulation and the tendency to clot. Additionally, prolonged ICU stay, high APACHE score and mechanical ventilation are indicative of heightened risk.1, 2VTE1

As resuscitation and stabilisation is prioritised on admission, early signs and symptoms of VTE may be masked and further obscured by supportive interventions. As VTE can be difficult to diagnose,3 even extensive thrombi may be present, but remain undetected.4

With sub-optimal prophylaxis, the risk of VTE in ICU patients may be as high as 80%.5 Even with preventative measures, up to 15% of patients6 will be diagnosed with VTE, many during their first week of admission.7

To help minimise VTE risk, anticoagulants are routinely administered, unless contraindicated, and generally used in combination with mechanical methods for this highest risk group. Intermittent pneumatic compression (IPC) moves blood in the deep veins of the leg in patients with reduced mobility,8 while enhancing fibrinolysis.9

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References:

  1. Minet C, Potton L, Bonadona A et al. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophyalxis. Critical Care. 2015; 19: 287

  2. Adriance SM, Murphy CV. Prophylaxis and treatment of venous thromboembolism in the critically ill. Int J Crit Illn Inj Sci. 2013; 3: 143-151

  3. Mcleod AG, Geerts W. Venous Thromboembolism Prophylaxis in Critically Ill Patients. Crit Care Clin. 2011; 27: 765-780

  4. Geerts W, Code K & Jay RA. Prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994; 331: 1601-1606

  5. Attia J, Ray JG, Cook D et al. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001; 161: 1268-1279

  6. Duranteau J, Taccone FS, Verhamme P et al. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol. 2018; 35: 142-14

  7. Attia J, Ray JG, Cook D et al. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001; 161: 1268-1279

  8. Ho KM(2014). Benefit of intermittent pneumatic compression of lower limbs in reducing venous thromboembolism in hospitalised patients: interactions between risk and effectiveness. Anaesth Intensive Care.;42(1):140-1
  9. Comerato, A.J., Chouhan, V (1997) The fibinolytic effects of Intermittent pneumatic compression. Mechanism of enhanced fibrinolysis. Annals of Surgery. 226(3) 306-314