Some thought about DVT prophylaxis in ICU.
Part of my presentation on the same topic.

Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis?
#FOAMed
Some thought about DVT prophylaxis in ICU.Part of my presentation on the same topic.Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis? #FOAMed
Some thought about DVT prophylaxis in ICU.Part of my presentation on the same topic.Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis? #FOAMed
Some thought about DVT prophylaxis in ICU.Part of my presentation on the same topic.Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis? #FOAMed
Some thought about DVT prophylaxis in ICU.Part of my presentation on the same topic.Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis? #FOAMed
Question 2: How do you diagnose DVT in ICU?
▶️I think, the best evidence is available for CUS with limited scope for Venography.
And no role of D-Dimer.
#FOAMed
Question 2: How do you diagnose DVT in ICU? I think, the best evidence is available for CUS with limited scope for Venography.And no role of D-Dimer. #FOAMed
Question 2: How do you diagnose DVT in ICU? I think, the best evidence is available for CUS with limited scope for Venography.And no role of D-Dimer. #FOAMed
Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU?
#FOAMed

Yes.
1⃣Number needed to prophylax to prevent 1 DVT - 20
2⃣Number needed to prophylax to prevent 1 PE - 52
3⃣Overall no major bleeding. But bleeding risk need to be individualised.
Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU? #FOAMedYes.Number needed to prophylax to prevent 1 DVT - 20Number needed to prophylax to prevent 1 PE - 52Overall no major bleeding. But bleeding risk need to be individualised.
Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU? #FOAMedYes.Number needed to prophylax to prevent 1 DVT - 20Number needed to prophylax to prevent 1 PE - 52Overall no major bleeding. But bleeding risk need to be individualised.
Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU? #FOAMedYes.Number needed to prophylax to prevent 1 DVT - 20Number needed to prophylax to prevent 1 PE - 52Overall no major bleeding. But bleeding risk need to be individualised.
Question 3: Is there any evidence supporting Heparin thrombo-prophylaxis in ICU? #FOAMedYes.Number needed to prophylax to prevent 1 DVT - 20Number needed to prophylax to prevent 1 PE - 52Overall no major bleeding. But bleeding risk need to be individualised.
Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis?
#FOAMeYes.
1⃣LMWH decreases DVT. But no difference in Proximal DVT.
2⃣No difference in PE.
3⃣No difference in major bleeding.
4⃣Lower incidence of HIT in LMWH (PROTECT Trial).
5⃣Overall advantage LMWH.
Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis? #FOAMeYes.LMWH decreases DVT. But no difference in Proximal DVT.No difference in PE.No difference in major bleeding.Lower incidence of HIT in LMWH (PROTECT Trial).Overall advantage LMWH.
Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis? #FOAMeYes.LMWH decreases DVT. But no difference in Proximal DVT.No difference in PE.No difference in major bleeding.Lower incidence of HIT in LMWH (PROTECT Trial).Overall advantage LMWH.
Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis? #FOAMeYes.LMWH decreases DVT. But no difference in Proximal DVT.No difference in PE.No difference in major bleeding.Lower incidence of HIT in LMWH (PROTECT Trial).Overall advantage LMWH.
Question 4: Is there any evidence of LMWH over UFH in VTE Prophylaxis? #FOAMeYes.LMWH decreases DVT. But no difference in Proximal DVT.No difference in PE.No difference in major bleeding.Lower incidence of HIT in LMWH (PROTECT Trial).Overall advantage LMWH.
Question 5: Is there any role of Mechanical Thromboprophylaxis?
#FOAMed
Question 6: What is the evidence for Pharmacological Thromboprophylaxis in patients with low CrCL?

1⃣Maximum evidence is for Dabigatran.
2⃣But unfortunately even on Dabigtran with adequate Anti-factor Xa level maintained both DVT and bleeding risk remains high.
#FOAMed
Question 7: Any evidence in TBI?
#FOAMed
Suggestions.
1⃣GCS 13-15. No bleed expansion at 48-H. Start.
2⃣GCS 13-15. Some expansion at 48-H. Start only after 72-H.
3⃣GCS 3-12. Not before 72 H. But before 7-days.
4⃣For DAI. No bleeding. Start after 72-H.
5⃣Consult Neurosurgery.
Question 8: How to treat DVT in ICU?
#FOAMed
1⃣Standard anticoagulation.
2⃣Limited role for Catheter Directed Thrombolysis.
Question 8: How to treat DVT in ICU? #FOAMedStandard anticoagulation.Limited role for Catheter Directed Thrombolysis.
Question 8: How to treat DVT in ICU? #FOAMedStandard anticoagulation.Limited role for Catheter Directed Thrombolysis.
Question 9: How do I provide DVT prophylaxis in my ICU?
#FOAMed

1⃣All ICU patients need DVT prophylaxis.
2⃣Pharmacological preferred over Mechanical.
3⃣If DVT prophylaxis not given for some reason, the reason must be documented.
Question 10: Is there any evidence for DOACs?
#FOAMed
1⃣Yes. For several of them.
2⃣APEX supports Betrixaban for prophylaxis.
3⃣Xalia supports Rivaroxaban for treatment.
4⃣But will be cautious in using them in my patients. Limited evidence in ICU patients. Limited reversal agent.
Question 10: Is there any evidence for DOACs? #FOAMedYes. For several of them.APEX supports Betrixaban for prophylaxis.Xalia supports Rivaroxaban for treatment.But will be cautious in using them in my patients. Limited evidence in ICU patients. Limited reversal agent.
Question 10: Is there any evidence for DOACs? #FOAMedYes. For several of them.APEX supports Betrixaban for prophylaxis.Xalia supports Rivaroxaban for treatment.But will be cautious in using them in my patients. Limited evidence in ICU patients. Limited reversal agent.
You can follow @dr_supradip.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled:
Those who think consciousness raising & movement building are disconnected, or even a distraction from electoral politics have not paid attention to the history of social change.In this thread, we
Read more
The 2020s will be known as the Remote Work decadeA few predictions of what is likely to emerge[ a thread ] Third Space: Office and Working from Home will
Read more
1/29: Have you ever had a concept explained to you that helps frame complex issues you’ve been wrestling with and opens your eyes to new possibilities? A concept that I
Read more
By continuing to use the site, you are consenting to the use of cookies as explained in our Cookie Policy to improve your experience.