Risk factors for venous thromboembolism in critically ill nontrauma surgical patients who cannot receive chemical prophylaxis.

BACKGROUND: We sought to identify independent predictors of venous thromboembolism in critically ill general surgery patients who cannot receive chemical prophylaxis in order to identify those who may benefit from aggressive screening and/or prophylactic inferior vena cava filter placement.

METHODS: Nontrauma patients in the surgical intensive care unit were prospectively followed for 2 years. Patients who had contraindications to prophylactic anticoagulation and received routine screening duplex examinations were included. Data regarding lower-extremity deep venous thrombosis or pulmonary embolism (PE) rates, past medical history (PMH), surgeries, and transfusions were collected. Logistic regression was used to identify independent predictors of lower-extremity deep venous thrombosis or PE (venous thromboembolism) with a P < .05.

RESULTS: Data were complete for 204 patients. Twenty (9.8%) patients developed venous thromboembolism. Independent predictors of venous thromboembolism included postoperative blood product requirements (odds ratio = 1.04 per unit), a PMH of PE (OR = 10.1), and a PMH of renal insufficiency (odds ratio = 5.1).

CONCLUSIONS: Aggressive screening and/or prophylactic inferior vena cava filter may be considered when prophylactic anticoagulation is prohibited in patients with increased postoperative transfusion requirements or a PMH of either PE or renal insufficiency.