Risk Characteristics And Intervention Status Of Venous Thromboembolism In ICU Inpatients

Objective:Risk assessment of Venous thromboembolism(VTE)was performed for hospitalized patients in Intensive care units(ICU),to understand the proportion of high-risk VTE population and the distribution of high-risk factors in the ICU,and to evaluate the prevention and bleeding risk of high-risk VTE patients.Methods:Retrospective collect the clinical data of 728 patients who met the inclusion and exclusion criteria in the ICU Department of Handan First Hospital from January 2019 to June 2020.According to the American College of Chest Physicians(ACCP)version 9 guidelines suggested that application of Padua scoring tool for medical patients in the ICU inpatients VTE risk assessment,Caprini scoring tool for surgical patients in the ICU inpatients VTE risk assessment,and for patients at high risk of developing VTE bleeding risk assessment,investigation and prevention of VTE high-risk patients.Results:1.Among the 728 hospitalized ICU patients,471 were medical patients and 257 were surgical patients.2.The disease composition of 471 medical patients including:Severe respira tory diseases,(including chronic obstructive pulmonary disease,severe pneumonia and respiratory failure)in 91 cases(19.32%),80 cases of heart failure(16.99%),75 cases of acute myocardial infarction(15.92%),59 cases of renal insufficiency(12.53%),41 cases of acute infection(8.70%),32 cases of acute cerebral ischemicstro ke(6.79%),24 cases of cardiac arrhythmia(5.10%),19 cases of malignant tumors(4.03%),14 cases of poisoning(2.97%),10 cases of acute pancreatitis(2.12%),26cases with unclear diagnosis and disease(5.52%).3.257 cases of surgical patients including:65 cases of abdominal surgery(25.29%),52 cases of craniotomy(20.23%),50 cases of orthopedic surgery(19.46%),32 cases of thoracic surgery(12.45%),21 cases of cardiac surgery(8.17%),20 cas es of interventional surgery(7.78%),17 cases of obstetrics and gynecology surger y(6.61%).4.Among the 471 medical patients evaluated by Pudua scoring tool,87 patients(18.47%)were at low risk and 384 patients(81.53%)were at high risk.Of the 257surgical patients evaluated by Caprini scoring tool,8(3.11%)were low-risk,21(8.17%)were medium-risk,and 228(88.72%)were high-risk.5.The most common risk factors for VTE in medical patients assessed by the Padua scoring instrument were>72h in bed(56.48%),age≥70 years old(37.79%),heart and/or respiratory failure(27.81%),acute myocardial infarction and/or ischemic stroke(25.69%).The most common risk factors for VTE in surgical patients assessed by Caprini scoring instrument were central venous catheterization(69.26%),>72h in bed(59.14%),>45min in major open surgery(35.80%)and BMI>25kg/m~2(30.74%).6.Under Padua scoring,198(51.56%)of 384 patients at high risk of VTE in medical patients had higher blood risk.Under Caprini scoring,75(32.89%)of 228patients at high risk of VTE in surgical patients had higher blood risk.7.326(44.78%)of 728 ICU inpatients received VTE prophylaxis.Among 384patients at high risk for medical VTE,112(29.17%)had taken preventive measures,and among 228 patients at high risk for surgical VTE,59(25.88%)had taken preventive measures.8.VTE occurred in 97 patients(13.32%)during hospitalization.VTE occurred in71 of 471 medical patients(15.07%);VTE occurred in 26 of 257 surgical patients(10.12%).Padua score of medical patients in VTE group was higher than that in non-VTE group,and the difference was statistically significant(P<0.001).Caprini score of surgical patients in VTE group was higher than that in non-VTE group,and the difference was statistically significant(P<0.001).Conclusions:In patients in ICU have a higher risk of VTE,the risk assessment of VTE is still inadequate,and the proportion of patients at high risk of VTE taking preventive measures is relatively low.The prevention awareness of VTE is weak among ICU physicians,and the prevention measures of VTE need to be improved.Patients with high risk of bleeding accounted for a high proportion in ICU inpatients,and anticoagulant measures should be carefully implemented.