Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit

François Lauzier; John Muscedere; Éric Deland; Demetrios J. Kutsogiannis; Michael Jacka; Diane Heels-Ansdell; Mark Crowther; Rodrigo Cartin-Ceba; Michael J. Cox; Nicole Zytaruk; Denise Foster; Tasnim Sinuff; France Clarke; Patrica Thompson; Steven Hanna; Deborah Cook; Rick Hall; Lisa Julien; Michelle St. Laurent; Maureen Meade; Lori Hand; Ann Laberge; Lauralyn McIntyre; Guiseppe Pagliarello; Irene Watpool; Tracy McArdle; Allyshia Van Tol; Nicole Zito; Amanda Van Beinum; Lana Antoinette Castellucci; Shawna Reddie; Yoanna Skrobik; Johanne Harvey; Brigitte Beauregard; Martin Albert; David Williamson; Guilaine Coralie; Sangeeta Mehta; Maedean Brown; Rottem Kuint; Robert Fowler; Nicole Marinoff; Ashwati Raghunath; Alexandra Rousseau; John Marshall; Orla Smith; Yoon Lee; Melissa Wang; Pragma Roy; Raphael Faraj; Susan Fleury; Nicole Godfrey; Donald Griesdale; Susan Logie; Greg Martinka; Peter Dodek; Betty Jean Ashley; Sabrina Anis; Kelsey Brewer; Sarah Shepherd; Francois Lellouche; Marie Claude Ferland; Tim Karachi; Marleen Irwin; Shanice Hannigan; Emily Gentles; Gordon Wood; Fiona Auld; Leslie Atkins; François Lamontagne; Marylise Parent; Chantal Langevin; Bojan Paunovic; Nicole Marten; Shauna Eggerton; Darlene Jossy; Samara Bush; Hari Kumar; Patricia Shea; Marios Roussos; Sandra Stoger; Cindy Cryderman; Kathleen Romano; Amanda Carli; Deanna Hicklin; Laurie Meade; Gregory Wilson; Tami Krpata; Alberto Marquez; Jackie O'Brien; Catherine Krause; Margaret Cyton; Kimberly Fowler; Catherine Hubert; Ceilidh Barlow Cash; Katherine Krolicki; Laurel Grainger

doi:10.1186/cc13844

Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit

François Lauzier, John Muscedere, Éric Deland, Demetrios J. Kutsogiannis, Michael Jacka, Diane Heels-Ansdell, Mark Crowther, Rodrigo Cartin-Ceba, Michael J. Cox, Nicole Zytaruk, Denise Foster, Tasnim Sinuff, France Clarke, Patrica Thompson, Steven Hanna, Deborah Cook, Rick Hall, Lisa Julien, Michelle St. Laurent, Maureen MeadeLori Hand, Ann Laberge, Lauralyn McIntyre, Guiseppe Pagliarello, Irene Watpool, Tracy McArdle, Allyshia Van Tol, Nicole Zito, Amanda Van Beinum, Lana Antoinette Castellucci, Shawna Reddie, Yoanna Skrobik, Johanne Harvey, Brigitte Beauregard, Martin Albert, David Williamson, Guilaine Coralie, Sangeeta Mehta, Maedean Brown, Rottem Kuint, Robert Fowler, Nicole Marinoff, Ashwati Raghunath, Alexandra Rousseau, John Marshall, Orla Smith, Yoon Lee, Melissa Wang, Pragma Roy, Raphael Faraj, Susan Fleury, Nicole Godfrey, Donald Griesdale, Susan Logie, Greg Martinka, Peter Dodek, Betty Jean Ashley, Sabrina Anis, Kelsey Brewer, Sarah Shepherd, Francois Lellouche, Marie Claude Ferland, Tim Karachi, Marleen Irwin, Shanice Hannigan, Emily Gentles, Gordon Wood, Fiona Auld, Leslie Atkins, François Lamontagne, Marylise Parent, Chantal Langevin, Bojan Paunovic, Nicole Marten, Shauna Eggerton, Darlene Jossy, Samara Bush, Hari Kumar, Patricia Shea, Marios Roussos, Sandra Stoger, Cindy Cryderman, Kathleen Romano, Amanda Carli, Deanna Hicklin, Laurie Meade, Gregory Wilson, Tami Krpata, Alberto Marquez, Jackie O'Brien, Catherine Krause, Margaret Cyton, Kimberly Fowler, Catherine Hubert, Ceilidh Barlow Cash, Katherine Krolicki, Laurel Grainger

Pulmonary and Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg² increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.

Original language	English (US)
Article number	R82
Journal	Critical Care
Volume	18
Issue number	2
DOIs	https://doi.org/10.1186/cc13844
State	Published - Apr 25 2014

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1186/cc13844

Cite this

Lauzier, F., Muscedere, J., Deland, É., Kutsogiannis, D. J., Jacka, M., Heels-Ansdell, D., Crowther, M., Cartin-Ceba, R., Cox, M. J., Zytaruk, N., Foster, D., Sinuff, T., Clarke, F., Thompson, P., Hanna, S., Cook, D., Hall, R., Julien, L., St. Laurent, M., ... Grainger, L. (2014). Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit. Critical Care, 18(2), Article R82. https://doi.org/10.1186/cc13844

Lauzier, F, Muscedere, J, Deland, É, Kutsogiannis, DJ, Jacka, M, Heels-Ansdell, D, Crowther, M, Cartin-Ceba, R, Cox, MJ, Zytaruk, N, Foster, D, Sinuff, T, Clarke, F, Thompson, P, Hanna, S, Cook, D, Hall, R, Julien, L, St. Laurent, M, Meade, M, Hand, L, Laberge, A, McIntyre, L, Pagliarello, G, Watpool, I, McArdle, T, Van Tol, A, Zito, N, Van Beinum, A, Castellucci, LA, Reddie, S, Skrobik, Y, Harvey, J, Beauregard, B, Albert, M, Williamson, D, Coralie, G, Mehta, S, Brown, M, Kuint, R, Fowler, R, Marinoff, N, Raghunath, A, Rousseau, A, Marshall, J, Smith, O, Lee, Y, Wang, M, Roy, P, Faraj, R, Fleury, S, Godfrey, N, Griesdale, D, Logie, S, Martinka, G, Dodek, P, Ashley, BJ, Anis, S, Brewer, K, Shepherd, S, Lellouche, F, Ferland, MC, Karachi, T, Irwin, M, Hannigan, S, Gentles, E, Wood, G, Auld, F, Atkins, L, Lamontagne, F, Parent, M, Langevin, C, Paunovic, B, Marten, N, Eggerton, S, Jossy, D, Bush, S, Kumar, H, Shea, P, Roussos, M, Stoger, S, Cryderman, C, Romano, K, Carli, A, Hicklin, D, Meade, L, Wilson, G, Krpata, T, Marquez, A, O'Brien, J, Krause, C, Cyton, M, Fowler, K, Hubert, C, Barlow Cash, C, Krolicki, K & Grainger, L 2014, 'Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit', Critical Care, vol. 18, no. 2, R82. https://doi.org/10.1186/cc13844

@article{f9ed9b0131f84883932b0ef503d59c66,

title = "Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit",

abstract = "Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.",

author = "Fran{\c c}ois Lauzier and John Muscedere and {\'E}ric Deland and Kutsogiannis, {Demetrios J.} and Michael Jacka and Diane Heels-Ansdell and Mark Crowther and Rodrigo Cartin-Ceba and Cox, {Michael J.} and Nicole Zytaruk and Denise Foster and Tasnim Sinuff and France Clarke and Patrica Thompson and Steven Hanna and Deborah Cook and Rick Hall and Lisa Julien and {St. Laurent}, Michelle and Maureen Meade and Lori Hand and Ann Laberge and Lauralyn McIntyre and Guiseppe Pagliarello and Irene Watpool and Tracy McArdle and {Van Tol}, Allyshia and Nicole Zito and {Van Beinum}, Amanda and Castellucci, {Lana Antoinette} and Shawna Reddie and Yoanna Skrobik and Johanne Harvey and Brigitte Beauregard and Martin Albert and David Williamson and Guilaine Coralie and Sangeeta Mehta and Maedean Brown and Rottem Kuint and Robert Fowler and Nicole Marinoff and Ashwati Raghunath and Alexandra Rousseau and John Marshall and Orla Smith and Yoon Lee and Melissa Wang and Pragma Roy and Raphael Faraj and Susan Fleury and Nicole Godfrey and Donald Griesdale and Susan Logie and Greg Martinka and Peter Dodek and Ashley, {Betty Jean} and Sabrina Anis and Kelsey Brewer and Sarah Shepherd and Francois Lellouche and Ferland, {Marie Claude} and Tim Karachi and Marleen Irwin and Shanice Hannigan and Emily Gentles and Gordon Wood and Fiona Auld and Leslie Atkins and Fran{\c c}ois Lamontagne and Marylise Parent and Chantal Langevin and Bojan Paunovic and Nicole Marten and Shauna Eggerton and Darlene Jossy and Samara Bush and Hari Kumar and Patricia Shea and Marios Roussos and Sandra Stoger and Cindy Cryderman and Kathleen Romano and Amanda Carli and Deanna Hicklin and Laurie Meade and Gregory Wilson and Tami Krpata and Alberto Marquez and Jackie O'Brien and Catherine Krause and Margaret Cyton and Kimberly Fowler and Catherine Hubert and {Barlow Cash}, Ceilidh and Katherine Krolicki and Laurel Grainger",

note = "Funding Information: This study was funded by the Hamilton Academy of Health Sciences. FL is a recipient of a Research Career Award from the Fonds de la recherche du Qu{\'e}bec-Sant{\'e}. DC holds a Chair of the Canadian Institutes of Health Research. The authors are grateful for the support of the Canadian Critical Care Trials Group. They are grateful to Dr H Stelfox and Dr C Martin for their suggestions on earlier drafts of this manuscript. The authors sincerely thank the Research Coordinators and Investigators who participated in this study (listed below). Funding Information: MC sat on advisory boards for Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, and Artisan Pharma; prepared educational materials for Pfizer, Octapharm, and CSL Behring; and provided expert testimony for Bayer. MC{\textquoteright}s institution has received funding for research projects from Boehringer Ingelheim, Octapharm, Pfizer, and Leo Pharma. DC received peer review funding from CIHR for the randomized trial PROTECT comparing unfractionated heparin versus the low molecular weight dalteparin. Pfizer and Eisai Inc. donated dalteparin. NZ and DH-A received conference support from Pfizer. The remaining authors declare that they have no competing interests.",

year = "2014",

month = apr,

day = "25",

doi = "10.1186/cc13844",

language = "English (US)",

volume = "18",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

number = "2",

}

TY - JOUR

T1 - Thromboprophylaxis patterns and determinants in critically ill patients

T2 - A multicenter audit

AU - Lauzier, François

AU - Muscedere, John

AU - Deland, Éric

AU - Kutsogiannis, Demetrios J.

AU - Jacka, Michael

AU - Heels-Ansdell, Diane

AU - Crowther, Mark

AU - Cartin-Ceba, Rodrigo

AU - Cox, Michael J.

AU - Zytaruk, Nicole

AU - Foster, Denise

AU - Sinuff, Tasnim

AU - Clarke, France

AU - Thompson, Patrica

AU - Hanna, Steven

AU - Cook, Deborah

AU - Hall, Rick

AU - Julien, Lisa

AU - St. Laurent, Michelle

AU - Meade, Maureen

AU - Hand, Lori

AU - Laberge, Ann

AU - McIntyre, Lauralyn

AU - Pagliarello, Guiseppe

AU - Watpool, Irene

AU - McArdle, Tracy

AU - Van Tol, Allyshia

AU - Zito, Nicole

AU - Van Beinum, Amanda

AU - Castellucci, Lana Antoinette

AU - Reddie, Shawna

AU - Skrobik, Yoanna

AU - Harvey, Johanne

AU - Beauregard, Brigitte

AU - Albert, Martin

AU - Williamson, David

AU - Coralie, Guilaine

AU - Mehta, Sangeeta

AU - Brown, Maedean

AU - Kuint, Rottem

AU - Fowler, Robert

AU - Marinoff, Nicole

AU - Raghunath, Ashwati

AU - Rousseau, Alexandra

AU - Marshall, John

AU - Smith, Orla

AU - Lee, Yoon

AU - Wang, Melissa

AU - Roy, Pragma

AU - Faraj, Raphael

AU - Fleury, Susan

AU - Godfrey, Nicole

AU - Griesdale, Donald

AU - Logie, Susan

AU - Martinka, Greg

AU - Dodek, Peter

AU - Ashley, Betty Jean

AU - Anis, Sabrina

AU - Brewer, Kelsey

AU - Shepherd, Sarah

AU - Lellouche, Francois

AU - Ferland, Marie Claude

AU - Karachi, Tim

AU - Irwin, Marleen

AU - Hannigan, Shanice

AU - Gentles, Emily

AU - Wood, Gordon

AU - Auld, Fiona

AU - Atkins, Leslie

AU - Lamontagne, François

AU - Parent, Marylise

AU - Langevin, Chantal

AU - Paunovic, Bojan

AU - Marten, Nicole

AU - Eggerton, Shauna

AU - Jossy, Darlene

AU - Bush, Samara

AU - Kumar, Hari

AU - Shea, Patricia

AU - Roussos, Marios

AU - Stoger, Sandra

AU - Cryderman, Cindy

AU - Romano, Kathleen

AU - Carli, Amanda

AU - Hicklin, Deanna

AU - Meade, Laurie

AU - Wilson, Gregory

AU - Krpata, Tami

AU - Marquez, Alberto

AU - O'Brien, Jackie

AU - Krause, Catherine

AU - Cyton, Margaret

AU - Fowler, Kimberly

AU - Hubert, Catherine

AU - Barlow Cash, Ceilidh

AU - Krolicki, Katherine

AU - Grainger, Laurel

N1 - Funding Information: This study was funded by the Hamilton Academy of Health Sciences. FL is a recipient of a Research Career Award from the Fonds de la recherche du Québec-Santé. DC holds a Chair of the Canadian Institutes of Health Research. The authors are grateful for the support of the Canadian Critical Care Trials Group. They are grateful to Dr H Stelfox and Dr C Martin for their suggestions on earlier drafts of this manuscript. The authors sincerely thank the Research Coordinators and Investigators who participated in this study (listed below). Funding Information: MC sat on advisory boards for Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, and Artisan Pharma; prepared educational materials for Pfizer, Octapharm, and CSL Behring; and provided expert testimony for Bayer. MC’s institution has received funding for research projects from Boehringer Ingelheim, Octapharm, Pfizer, and Leo Pharma. DC received peer review funding from CIHR for the randomized trial PROTECT comparing unfractionated heparin versus the low molecular weight dalteparin. Pfizer and Eisai Inc. donated dalteparin. NZ and DH-A received conference support from Pfizer. The remaining authors declare that they have no competing interests.

PY - 2014/4/25

Y1 - 2014/4/25

N2 - Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.

AB - Introduction: Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk.Methods: We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH.Results: We enrolled 1,935 patients (62.3 ± 16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1 ± 8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23).Conclusions: Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target.

UR - http://www.scopus.com/inward/record.url?scp=84901593223&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901593223&partnerID=8YFLogxK

U2 - 10.1186/cc13844

DO - 10.1186/cc13844

M3 - Article

C2 - 24766968

AN - SCOPUS:84901593223

SN - 1364-8535

VL - 18

JO - Critical Care

JF - Critical Care

IS - 2

M1 - R82

ER -

Thromboprophylaxis patterns and determinants in critically ill patients: A multicenter audit

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