[Thrombosis prophylaxis with heparins in intensive care patients]

A Greinacher, D Janssen
Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 2005, 40 (3): 156-63
Venous thromboembolism is a common complication in critically ill patients, resulting in high morbidity and mortality. Most patients treated in intensive care units (ICU) face a high risk of thromboembolic complications. There is a need for well-defined strategies for prevention of thrombosis in ICU patients. Mechanical methods such as compression stockings are frequently used, even though evidence for these measures in ICU patients is limited. Unfractionated heparin (UFH) is still the leading drug for thromboprophylaxis in ICU patients, but pharmacokinetic disadvantages such as low predictability of effect on anticoagulation are relevant, especially in ICU patients. Additionally, there is no sufficient evidence from clinical trials to support subcutaneous or intravenous prophylaxis with UFH. At least equivalent efficacy and safety of subcutaneous low molecular weight heparin (LMWH) compared with subcutaneous UFH have been shown in numerous studies investigating non-ICU high-risk groups. First studies on the use of LMWH in critically ill patients are promising. Some conclusions for safe use of subcutaneous LMWH in ICU patients can be drawn. Intravenous LMWH may be the optimal prophylaxis in most ICU patients, but there is a lack of sufficient data on dosing. Precautions such as monitoring of anticoagulation in patients with renal insufficiency are fundamental if LMWH is given. Further investigations into prevention of venous thromboembolism in ICU patients are urgently needed.


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