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Table 2 Venous thromboembolism prophylaxis administration practices in the intensive care unit

From: Compliance with American College of Chest Physicians (ACCP) recommendations for thromboembolic prophylaxis in the intensive care unit: a level I trauma center experience

  All Trauma service Non–trauma service P
n = 200 n = 102 n = 98
VTE prophylaxis administered 199 (99%) 101 (99%) 98 (100%) 0.99
 Pharmacologic prophylaxis administered 98 (49%) 55 (54%) 43 (44%) 0.16
 Mechanical prophylaxis administered 197 (98%) 100 (98%) 97 (99%) 0.99
VTE prophylaxis type
 Mechanical only 101 (51%) 46 (45%) 55 (56%) 0.12
 Pharmacologic only 2 (1%) 1 (1%) 1 (1%) 0.99
 Both 96 (48%) 54 (53%) 42 (43%) 0.15
Pharmacologic prophylaxis administered     < 0.01
 Enoxaparin only 71 (73%) 52 (95%) 19 (45%)  
 Heparin only 17 (18%) 3 (5%) 14 (33%)  
 Apixaban only 1 (1%) 0 (0%) 1 (2%)  
 Heparin, followed by enoxaparin 4 (4%) 0 (0%) 4 (10%)  
 Enoxaparin, followed by heparin 2 (2%) 0 (0%) 2 (5%)  
 Enoxaparin, followed by apixaban 1 (1%) 0 (0%) 1 (2%)  
 Simultaneous heparin and enoxaparin 1 (1%) 0 (0%) 1 (2%)  
Interruption of pharmacologic prophylaxis after initiation 10 (10%) 5 (9%) 5 (12%) 0.74
 Interruption of enoxaparin 8 (10%) 5 (10%) 3 (11%) 0.99
 Interruption of heparin 2 (8%) 0 (0%) 2 (9%) 0.99
Time between admission and pharmacologic prophylaxis initiation (hours), median (IQR) 23 (8–76) 53 (15–107) 10 (2–25) < 0.01
 Admission to enoxaparin initiation (hours), median (IQR) 30 (14–77) 53 (15–95) 17 (4–25) < 0.01
 Admission to heparin initiation (hours), median (IQR) 7 (0–29) 131 (17–188) 4 (0–21) 0.03
 Admission to apixaban initiation (hours), median (IQR) 2 (2–2) 2 (2–2)
Reasons for non-administration or interruption of prophylaxis
 Holding for procedurea 26 (46%) 14 (67%) 12 (33%) 0.03
 Active bleed 17 (30%) 8 (38%) 9 (25%) 0.30
 Recent TBI (≤48 h) 17 (30%) 12 (57%) 5 (14%) < 0.01
 High bleeding risk 3 (5%) 0 (0%) 3 (8%) 0.30
 Low platelet count (< 50,000) 3 (5%) 1 (5%) 2 (6%) 0.90
 Epidural catheter 2 (4%) 2 (10%) 0 (0%) 0.13
 Intracranial pressure monitor 1 (2%) 1 (5%) 0 (0%) 0.37
 Otherb 13 (29%) 4 (19%) 9 (25%) 0.75
No documented reason for treatment holding or interruption 9 (16%) 0 (0%) 9 (25%) 0.01
  1. Bold indicates statistically significant results at a threshold of P ≤ 0.05. VTE venous thromboembolism, IQR interquartile range, TBI traumatic brain injury. aProcedures resulting in prophylaxis holds: ankle fixation, brain biopsy, bronchoscopy, burr hole, coronary artery bypass graft, cardiac repair, craniotomy, endovascular coiling, image-guided percutaneous abscess drainage, inferior vena cava filter placement, massive transfusion protocol, open reduction internal fixation, odontoid screw fixation, removal of epidural catheter, sacroiliac screw fixation, tracheostomy, ulnar repair. bOther documented reasons for holding: cardiac issues, change in diagnosis, undefined contraindication to pharmacologic prophylaxis, code, diagnosis changed to stroke, INR not reaching subtherapeutic goal, open gastrostomy tube, patient religious objections, transfer to another hospital, and patient-requested withdrawal of care