Epworth Healthcare, Melbourne, VIC.
Crit Care Resusc. 2010 Mar;12(1):9-15.
Critically ill patients are at high risk of morbidity and mortality caused by venous thromboembolism (VTE). In addition to premorbid predisposing conditions, critically ill patients may be exposed to prolonged immobility, invasive intravascular catheters and frequent operative procedures, and further may have contraindications to pharmaceutical prophylactic measures designed to attenuate VTE risk. There are limited data describing current VTE prophylaxis regimens in Australia and New Zealand.
To document current Australian and New Zealand management of VTE prophylaxis in a large mixed cohort of critically ill patients.
Prospective, multicentre point prevalence survey endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG).
30 public hospital ICUs in Australia and New Zealand surveyed on Wednesday 9 May 2007.
For all patients in each ICU on the study day, demographic data, admission diagnosis and information on VTE prophylaxis were prospectively collected.
502 patients were included in the survey, and 431 of these (86%) received VTE prophylaxis. Of these, 64% (276/431) received pharmacological prophylaxis and 80% (345/431) received mechanical prophylaxis, with 44% (190/431) receiving both. Of those receiving pharmacological prophylaxis, unfractionated heparin was used in 74%, and enoxaparin (low molecular weight heparin) in 23%. Contraindications to pharmacological prophylaxis were reported in 122 patients. Overall, pharmacological prophylaxis was administered to 87% of potentially suitable patients.
We observed a high prevalence of VTE prophylaxis, with many critically ill patients receiving two or more modalities of prophylaxis. These results show that the potential risk of VTE in critically ill patients is recognised in Australia and New Zealand, and strategies to mitigate this serious complication are widely implemented.
危重症患者存在静脉血栓栓塞症（VTE）导致发病率和死亡率升高的风险。除了潜在的致病因素外，危重症患者可能长期处于无法活动状态、有侵入性的血管内导管和频繁的手术操作，并且可能对旨在降低 VTE 风险的药物预防措施存在禁忌。目前，关于澳大利亚和新西兰的 VTE 预防方案的数据有限。
描述在大型混合危重症患者队列中，目前澳大利亚和新西兰的 VTE 预防管理措施。
前瞻性、多中心时点患病率调查，由澳大利亚和新西兰重症监护学会临床试验组（ANZICS CTG）认可。
2007 年 5 月 9 日星期三对澳大利亚和新西兰的 30 家公立医院 ICU 进行调查。
对研究日每个 ICU 中的所有患者，前瞻性收集人口统计学数据、入院诊断和 VTE 预防信息。
共纳入 502 例患者，其中 431 例（86%）接受了 VTE 预防。其中，64%（276/431）接受了药物预防，80%（345/431）接受了机械预防，44%（190/431）同时接受了两种预防。接受药物预防的患者中，74%使用的是普通肝素，23%使用的是依诺肝素（低分子肝素）。122 例患者报告存在药物预防的禁忌证。总体而言，有潜在预防适应证的患者中，87%接受了药物预防。
我们观察到 VTE 预防的高患病率，许多危重症患者接受了两种或更多种预防措施。这些结果表明，静脉血栓栓塞症的潜在风险在澳大利亚和新西兰得到了认识，并且广泛实施了降低这一严重并发症风险的策略。
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