Chest
Original ResearchCritical CareThrombosis Prophylaxis and Mortality Risk Among Critically Ill Adults
Section snippets
Materials and Methods
The primary outcomes of this cohort study were adjusted ICU and hospital mortality among groups of critically ill adults managed with prophylactic anticoagulation therapy, thromboprophylaxis with a mechanical device, both, or neither, as assigned by clinical judgment. The study included all adult patients discharged alive or dead from participating ICUs from January 1, 2008, to September 30, 2010. Data were derived from patient information contained in the Philips eICU Research Institute data
Patient Characteristics
This study included records from 294,896 hospital discharge events from 5,321 adult ICU beds in 271 ICUs located in 188 hospitals and 32 health-care systems from 31 states. Patients who failed to meet age, date, or validity criteria or were not at risk for VTE were excluded from the study (Fig 1). Patient demographic characteristics by VTE prophylaxis group are presented in Table 1. Almost all patients (93%) were treated with some form of VTE prophylaxis; a combination of prophylactic
Discussion
The main finding of this large observational study is that adult patients in the ICU who are managed with prophylactic anticoagulation have lower adjusted mortality than those managed with mechanical devices or not provided thrombosis prophylaxis. The risks of ICU and in-hospital mortality in patients managed without VTE prophylaxis were lower than in those managed with VTE prophylaxis based on analyses that did not adjust for differences in acuity (Table 2). Analyses that adjusted for acuity,
Acknowledgments
Author contributions: C. M. L. had full access to the data and takes responsibility for its integrity and the accuracy of the analyses. C. M. L., O. B., and I. H. Z. contributed to the study concept; C. M. L., X. L., O. B., C. S. F., and I. H. Z. contributed to the study design; C. M. L. and O. B. contributed to data acquisition; C. M. L., X. L., O. B., C. S. F., and I. H. Z. contributed to data interpretation; X. L., O. B., C. S. F., and I. H. Z. contributed to data analysis; X. L. and C. S.
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FUNDING/SUPPORT: The database and support for analyses performed by Drs Liu and Zuckerman and Ms Franey were provided by the eICU Research Institute.
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