Cook Deborah J, Douketis James, Arnold Donald, Crowther Mark A
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Curr Opin Pulm Med. 2009 Sep;15(5):455-62. doi: 10.1097/MCP.0b013e32832ea4dd.
The purpose of this review is to critique and summarize clinical literature relevant to thromboprophylaxis in critically ill patients with renal insufficiency. The specific objectives are to discuss factors that increase the risks for bleeding and venous thromboembolism in critically ill patients, with a focus on patients with renal insufficiency, and to consider prophylaxis management options and the rationale for their use.
Herein, we discuss both bleeding and venous thromboembolism in this population, both of which are of concern as complications. Bleeding is common among critically ill patients and has important clinical consequences. Critically ill patients with renal insufficiency require special consideration in regard to thromboprophylaxis. Such patients have a four-fold higher risk for developing venous thromboembolism compared with ICU patients without renal insufficiency. ICU patients have dynamic risks of thrombosis and bleeding. Invasive procedures may require temporary interruption of anticoagulants. Consequently, approaches to thromboprophylaxis require daily reevaluation.
We provide some considerations for practice in the conclusion section.
本综述旨在对与肾功能不全的危重症患者血栓预防相关的临床文献进行批判性分析和总结。具体目标是讨论增加危重症患者出血和静脉血栓栓塞风险的因素，重点关注肾功能不全患者，并考虑预防管理方案及其使用的基本原理。
在此，我们讨论该人群中的出血和静脉血栓栓塞问题，这两者都是令人担忧的并发症。出血在危重症患者中很常见，并具有重要的临床后果。肾功能不全的危重症患者在血栓预防方面需要特别考虑。与没有肾功能不全的ICU患者相比，这类患者发生静脉血栓栓塞的风险高出四倍。ICU患者有血栓形成和出血的动态风险。侵入性操作可能需要暂时中断抗凝治疗。因此，血栓预防方法需要每日重新评估。
我们在结论部分提供了一些实践方面的考虑因素。
