Venous thromboembolism (VTE) is one of the costliest and most common preventable causes of death in the intensive care unit (ICU). In this month’s issue of Chest, Kwok Ho and colleagues utilized data from 134 ICUs in Australia and New Zealand to assess the association between omission of early thromboprophylaxis (>24 hours) after ICU admission and mortality.

This retrospective cohort included 175,665 patients. Omission of thromboprophylaxis occurred in 27,890 patients (15.9%), and was associated with an unadjusted mortality of 7.6%. When the investigators adjusted for other covariates with generalized estimating equations and logistic regression, the odds of death was statistically significantly greater for patients who did not have thromboprophylaxis within 24 hours (OR, 1.22; 95% confidence interval [CI], 1.15-1.30; P<0.01). An association with greater mortality was found in patients who did not have thromboprophylaxis and had multiple trauma (OR, 1.66; 95% CI, 1.22-2.25), sepsis (OR, 1.52; 95% CI, 1.27-1.81), and preexisting metastatic cancer (OR, 1.48; 95% CI, 1.17-1.87). Attributable mortality ranged from 3.9% to 15.4%.

This large observational trial demonstrated that omission of early thromboprophylaxis is associated with a statistically significantly higher risk of mortality in ICU patients.  As with all observational data sets, residual confounding, and other selection biases, might also explain this association; however, the authors appropriately employed robust statistical techniques to control for differences in baseline characteristics and known confounders.  This study adds compelling evidence in support of the recommendation by the National Quality Forum and the Joint Commission International to use thromboprophylaxis in ICU patients as soon as possible after admission. 

Concise Critical Appraisal is a regular feature authored by SCCM member Samuel M. Galvagno Jr., DO. Each installment highlights journal articles most relevant to the critical care practitioner.