ArticleThrombosis journal2025
Risk-adapted venous thromboembolism prophylaxis in Asian patients admitted to medical intensive care unit: a prospective controlled trial.
Article in Thrombosis journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCritically ill patients are at high risk for venous thromboembolism (VTE). In non-Caucasian patients, routine thromboprophylaxis is controversial. No standard guidelines exist for critically ill Thai patients.
objectivesTo evaluate the efficacy and safety of a risk-adapted VTE prophylaxis protocol in medically ill patients.
methodsA single-center, prospective pre- and post-implementation trial conducted from March to December 2024. Patients admitted to three medical ICUs were enrolled. Patients were stratified by risk of VTE and bleeding. In the pre-implementation phase, patients did not receive thromboprophylaxis, whereas in the post-implementation phase, patients received thromboprophylaxis with either pharmacological or mechanical prophylaxis. The primary outcome was the 45-day incidence of VTE, VTE-related death, and bleeding events. Secondary outcomes included all-cause mortality, ICU stay, and days on mechanical ventilation.
resultsThere were 462 patients enrolled with a mean age of 65.82 ± 16.65 years and 53.90% were male. In the post-implementation phase, 151 out of 211 patients (65.37%) received thromboprophylaxis, primarily with pneumatic compression (41.56%), low molecular weight heparin/unfractionated heparin (15.58%) and aspirin (7.36%). VTE events occurred in 14 patients (6.06%) in the pre-implementation group and 5 (2.16%) in the post-implementation group. The composite primary outcome occurred in 14 patients (6.06%, 95% CI 3.35-9.96%) in the pre-implementation group and 5 (2.16%, 95% CI 0.71-4.98%) in the post-implementation group (RR 0.35, 95% CI 0.13-0.97, P = 0.04). A competing-risks analysis showed that post-implementation group was associated with significantly lower risk of VTE (adjusted subdistribution hazard ratio 0.35, 95% CI 0.13-0.97; p = 0.043). No VTE-related deaths occurred. Overall bleeding occurred in 28.14% of pre-implementation and 32.03% of post-implementation patients (RR 1.13, 95% CI 0.86-1.50, P = 0.361). Major bleeding rates were 11.26% vs. 8.22%, respectively (RR 0.65, 95% CI 0.40-1.07, P = 0.075).
conclusionA risk-adapted VTE prophylaxis protocol significantly reduced VTE incidence in critically ill Asian patients without increasing bleeding complication. CLINICAL
trial registrationTCTR20230927002, First Posted Date: 27 September 2023.
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