Geerts William, Cook Deborah, Selby Rita, Etchells Edward
Department of Medicine and Health Policy, University of Toronto, Toronto, Canada.
J Crit Care. 2002 Jun;17(2):95-104. doi: 10.1053/jcrc.2002.33941.
Evidence-based guidelines for the prevention of venous thromboembolism (VTE) are available for most major surgical and medical patient groups. Such guidelines have not been established for critically ill patients.
To perform a systematic review of the prevalence of deep vein thrombosis (DVT), the efficacy of thromboprophylaxis, and the rates of thromboprophylaxis use in critically ill patients.
Computerized literature search for relevant studies meeting prespecified criteria.
The rates of objectively confirmed DVT in 4 prospective studies ranged from 13% to 31%. We identified only 3 randomized trials (1 in abstract form) of thromboprophylaxis in critical care unit patients. These studies show the efficacy of low-dose heparin and low molecular weight heparin compared with no prophylaxis; however, we found no trials comparing these 2 interventions. Eleven compliance studies reported that some form of thromboprophylaxis was used in 33% to 100% of critically ill patients, although only 1 study addressed the issue of appropriate prophylaxis use.
Data on the epidemiology of VTE and its prevention in critically ill patients are very limited. Further research is needed to better define patient risk factors for VTE, optimal methods of thromboprophylaxis, and strategies to improve compliance with prophylaxis recommendations. In the meantime, prevention strategies, shown to be effective in other related patient groups, and general principles of individual pharmacotherapy should guide the routine use of prophylaxis during critical illness.
针对大多数主要外科和内科患者群体，已有基于证据的静脉血栓栓塞症（VTE）预防指南。但尚未为重症患者制定此类指南。
对重症患者深静脉血栓形成（DVT）的患病率、血栓预防的疗效以及血栓预防措施的使用率进行系统评价。
通过计算机检索符合预定标准的相关研究。
4项前瞻性研究中经客观证实的DVT发生率在13%至31%之间。我们仅找到3项针对重症监护病房患者血栓预防的随机试验（1项为摘要形式）。这些研究表明，与不进行预防相比，低剂量肝素和低分子量肝素有预防效果；然而，我们未找到比较这两种干预措施的试验。11项依从性研究报告称，33%至100%的重症患者使用了某种形式的血栓预防措施，不过仅有1项研究涉及适当使用预防措施的问题。
关于重症患者VTE的流行病学及其预防的数据非常有限。需要进一步研究以更好地确定VTE的患者风险因素、最佳血栓预防方法以及提高对预防建议依从性的策略。与此同时，在其他相关患者群体中已证明有效的预防策略以及个体化药物治疗的一般原则应指导重症期间预防措施的常规使用。
