Comments on: Increased Mortality When Thromboprophylaxis Not Used http://www.sccmblogs.org/increased-mortality-when-thromboprophylaxis-not-used Critical Care Blogs Mon, 07 May 2012 22:32:25 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: SAM GALVAGNO http://www.sccmblogs.org/increased-mortality-when-thromboprophylaxis-not-used/comment-page-1#comment-384 SAM GALVAGNO Mon, 02 Jan 2012 18:46:54 +0000 http://www.sccmblogs.org/?p=571#comment-384 Dear. Dr. Fallahian, Indeed, as I practice in a mostly surgical ICU environment, I have to agree with you. Your points are very well taken. Have you seen the latest article on thromboprophylaxis in the NEJM (Kakkar et al., NEJM, 29 Dec 2011)? Elastic stockings with enoxaparin was no better than elastic stockings only. The research on how to best prevent VTE seems to be cloudy sometimes! Your point abotu the thromboelastogram is a great one, and in my hospital, it is a matter of working out the problems inherent with point-of-care testing. I agree with you that tests providing immediate insight into the coagulation status are invaluable from my perspective. Thank you for providing such a meaningful response! V/R, SAM Dear. Dr. Fallahian,

Indeed, as I practice in a mostly surgical ICU environment, I have to agree with you. Your points are very well taken. Have you seen the latest article on thromboprophylaxis in the NEJM (Kakkar et al., NEJM, 29 Dec 2011)? Elastic stockings with enoxaparin was no better than elastic stockings only. The research on how to best prevent VTE seems to be cloudy sometimes! Your point abotu the thromboelastogram is a great one, and in my hospital, it is a matter of working out the problems inherent with point-of-care testing. I agree with you that tests providing immediate insight into the coagulation status are invaluable from my perspective.

Thank you for providing such a meaningful response!

V/R,
SAM

]]> By: SAM GALVAGNO http://www.sccmblogs.org/increased-mortality-when-thromboprophylaxis-not-used/comment-page-1#comment-383 SAM GALVAGNO Mon, 02 Jan 2012 18:42:48 +0000 http://www.sccmblogs.org/?p=571#comment-383 Catherine, Great point! The authors considered one of ANY measures to be thromboprophylaxis. So, if elastic stockings or calf pumps were used, this counted as thromboprophylaxis. Thromboprophylaxis was not defined as simply medications only. I should have made this more clear, because it is important. Interesting, don't you think? Another article in the NEJM on LMWH vs. elastic stockings (Kakkar, 2011) showed that the use of enoxaparin plus elastic stockings, compared only with elastic stockings, was NOT associated with a reduction in death! Thank you for your comment, SAM Catherine,

Great point! The authors considered one of ANY measures to be thromboprophylaxis. So, if elastic stockings or calf pumps were used, this counted as thromboprophylaxis. Thromboprophylaxis was not defined as simply medications only. I should have made this more clear, because it is important.

Interesting, don’t you think? Another article in the NEJM on LMWH vs. elastic stockings (Kakkar, 2011) showed that the use of enoxaparin plus elastic stockings, compared only with elastic stockings, was NOT associated with a reduction in death!

Thank you for your comment,

SAM

]]> By: Catherine Scoon http://www.sccmblogs.org/increased-mortality-when-thromboprophylaxis-not-used/comment-page-1#comment-374 Catherine Scoon Fri, 16 Dec 2011 18:16:28 +0000 http://www.sccmblogs.org/?p=571#comment-374 When you refer to thromboprophylaxis, are your referring to pharmacologic prophylaxis only, or was mechanical prophylaxis included in this study? When you refer to thromboprophylaxis, are your referring to pharmacologic prophylaxis only, or was mechanical prophylaxis included in this study?

]]> By: f.fallahian http://www.sccmblogs.org/increased-mortality-when-thromboprophylaxis-not-used/comment-page-1#comment-373 f.fallahian Fri, 16 Dec 2011 05:21:55 +0000 http://www.sccmblogs.org/?p=571#comment-373 Some times on admission to ICU it takes time to take the permission for start of anticoagulat in an ICH/multiple trauma/GI bleeding case, while the use of pneumatic stockings and limb movement is not suffice. Do you recommend start the anticoagulant irrespective of other physicians involved in treatment of that patient? In SIRS we have coagulation cascade activation concomitantly with inflammatory pathways. Also many subjects I mean young ischemic CVA subjects with within borderline coagulation tests; preotein C,S, antithrombin III, prothrombin polymorphism,homocystein level, negative ANA, ds DNA, VDRL, ANCA,.... still response better to anticoagulant (for example heparin drip, and then warfarin ) and better response for rehabilitation. As thromboelastogram for bleeding diathesis, I think more detailed tests for coaculation/thrombosis affinity should be investigated to decrease the consequences of thrombosis and PTE. thanks Some times on admission to ICU it takes time to take the permission for start of anticoagulat in an ICH/multiple trauma/GI bleeding case, while the use of pneumatic stockings and limb movement is not suffice. Do you recommend start the anticoagulant irrespective of other physicians involved in treatment of that patient? In SIRS we have coagulation cascade activation concomitantly with inflammatory pathways. Also many subjects I mean young ischemic CVA subjects with within borderline coagulation tests; preotein C,S, antithrombin III, prothrombin polymorphism,homocystein level, negative ANA, ds DNA, VDRL, ANCA,…. still response better to anticoagulant (for example heparin drip, and then warfarin ) and better response for rehabilitation. As thromboelastogram for bleeding diathesis, I think more detailed tests for coaculation/thrombosis affinity should be investigated to decrease the consequences of thrombosis and PTE.
thanks

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