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What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients?
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU). Thromboprophylaxis is mainly performed with Low Molecular Weight Heparin (LMWH) and, in some specific patients, with Unfractionate...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389559/ https://www.ncbi.nlm.nih.gov/pubmed/34440068 http://dx.doi.org/10.3390/biomedicines9080864 |
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author | Cauchie, Philippe Piagnerelli, Michael |
author_facet | Cauchie, Philippe Piagnerelli, Michael |
author_sort | Cauchie, Philippe |
collection | PubMed |
description | Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU). Thromboprophylaxis is mainly performed with Low Molecular Weight Heparin (LMWH) and, in some specific patients, with Unfractionated Heparin (UFH). These intensive units are an environment where individual patient variability is extreme and where traditional antithrombotic protocols are frequently ineffective. This was known for a long time, but the hospitalization of many patients with COVID-19 inflammatory storms suddenly highlighted this knowledge. It is therefore reasonable to propose variable antithrombotic prevention protocols based initially on a series of individual criteria (weight, BMI, and thrombotic risks). Secondly, they should be adjusted by the monitoring of anticoagulant activity, preferably by measuring the anti-Xa activity. However, we still face unresolved questions, such as once- or twice-daily LMWH injections, monitoring at the peak and/or trough, and poorly defined therapeutic targets. Equally surprisingly, we observed a lack of standardization of the anti-Xa activity kits. |
format | Online Article Text |
id | pubmed-8389559 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-83895592021-08-27 What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? Cauchie, Philippe Piagnerelli, Michael Biomedicines Review Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an important complication in patients hospitalized in intensive care units (ICU). Thromboprophylaxis is mainly performed with Low Molecular Weight Heparin (LMWH) and, in some specific patients, with Unfractionated Heparin (UFH). These intensive units are an environment where individual patient variability is extreme and where traditional antithrombotic protocols are frequently ineffective. This was known for a long time, but the hospitalization of many patients with COVID-19 inflammatory storms suddenly highlighted this knowledge. It is therefore reasonable to propose variable antithrombotic prevention protocols based initially on a series of individual criteria (weight, BMI, and thrombotic risks). Secondly, they should be adjusted by the monitoring of anticoagulant activity, preferably by measuring the anti-Xa activity. However, we still face unresolved questions, such as once- or twice-daily LMWH injections, monitoring at the peak and/or trough, and poorly defined therapeutic targets. Equally surprisingly, we observed a lack of standardization of the anti-Xa activity kits. MDPI 2021-07-22 /pmc/articles/PMC8389559/ /pubmed/34440068 http://dx.doi.org/10.3390/biomedicines9080864 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Cauchie, Philippe Piagnerelli, Michael What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title | What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title_full | What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title_fullStr | What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title_full_unstemmed | What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title_short | What Do We Know about Thromboprophylaxis and Its Monitoring in Critically Ill Patients? |
title_sort | what do we know about thromboprophylaxis and its monitoring in critically ill patients? |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389559/ https://www.ncbi.nlm.nih.gov/pubmed/34440068 http://dx.doi.org/10.3390/biomedicines9080864 |
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