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Venous Thromboembolism Prophylaxis in Neurocritical Care Patients: Are Current Practices, Best Practices?

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Abstract

Background/Objectives

Venous thromboembolism (VTE) is a leading cause of preventable, in-hospital deaths; critically ill patients have a higher risk. Effective and efficient strategies to prevent VTE exist; however, neurocritical care patients present unique challenges due to competing risk of bleeding. The objective of this study was to examine current VTE prophylaxis practices among neurocritical care patients, concordance with guideline-recommended care, and the association with clinical outcomes.

Methods

This retrospective cohort study of patients admitted to ten adult, medical–surgical and neurological intensive care units (ICUs) in nine hospitals between 2014 and 2017 using administrative and clinical data. Neurocritical care patients were classified based on the primary admission diagnosis. Concordance with guideline-recommended care was evaluated using recommendations from recent guidelines.

Results

20.0% of 23,191 patients were classified as neurocritical care. Among neurocritical care patients, pharmacological VTE prophylaxis was administered on 60.9% of all ICU days, mechanical VTE prophylaxis on 46.9%, and no VTE prophylaxis on 12.2% of all ICU days. Type of VTE prophylaxis was associated with sex, neurological diagnosis, and invasive neurological monitoring. Fifty-six percentage of ICU days were guideline concordant but concordance varied by recommendation (range 6–100%) and by type of VTE prophylaxis recommended (p = 0.05); among patients where guidelines recommended use of pharmacologic prophylaxis, care was concordant 26.6% of ICU days, whereas for mechanical prophylaxis it was concordant 80.5% of ICU days. There was an overall improvement in guideline concordance on 2.3% of ICU days after the publication of the Society of Neurocritical Care guideline (p = 0.005).

Conclusions

Neurocritical care patients commonly receive mechanical VTE prophylaxis despite guidelines recommending the use of pharmacological VTE prophylaxis. Our findings suggest uncertainty around best VTE prophylaxis practices for neurocritical care patients remains.

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Acknowledgements

K. M. Sauro has received a postdoctoral fellowship from the Canadian Institute for Health Research, Ward of the 21st Century and O’Brien Institute for Public Health (Cumming School of Medicine, University of Calgary). S. M. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology. H. T. Stelfox is supported by an Embedded Clinician Research Award from the Canadian Institutes of Health Research.

Funding

There was no financial support provided for this project.

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada

    K. M. Sauro, A. Soo, A. Kramer, P. Couillard, J. Kromm, D. J. Niven & H. T. Stelfox

  2. Department of Community Health Science, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada

    K. M. Sauro, D. J. Niven & H. T. Stelfox

  3. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    A. Kramer & P. Couillard

  4. Department of Critical Care Medicine, School of Public Health, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    D. Zygun & S. M. Bagshaw

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  1. K. M. Sauro
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  9. H. T. Stelfox
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Contributions

KMS contributed to the design and conceptualization of the study, analysis and interpretation of the data, and drafting and revising the manuscript and gave approval of the final version of the manuscript; AS contributed to the analysis and interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; AK contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; PC contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; JK contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; DZ contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; DJN contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; SMB contributed to the interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript; HTS contributed to the design and conceptualization of the study, interpretation of the data, providing feedback on the manuscript, and gave approval of the final version of the manuscript.

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Correspondence to K. M. Sauro.

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Sauro, K.M., Soo, A., Kramer, A. et al. Venous Thromboembolism Prophylaxis in Neurocritical Care Patients: Are Current Practices, Best Practices?. Neurocrit Care 30, 355–363 (2019). https://doi.org/10.1007/s12028-018-0614-9

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  • DOI: https://doi.org/10.1007/s12028-018-0614-9

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