Thromboprophylaxis for Overweight Critically Ill Patients

Abstract

Venous thromboembolism (VTE) affects about 9% of ICU patients but is frequently asymptomatic. VTE increases ventilation duration, length of stay and mortality in intensive care unit (ICU) patients. Risk factors for VTE in critically ill patients are multiple, including obesity (body mass index [BMI]>30 kg/m²). As obesity concerns about 25% of ICU patients, VTE prophylaxis for ICU obese patients (OP) remains an important issue.

Because of lack of large randomized and adequately powered trials, no specific guidelines are available in ICU OP. As those patients have an increased VTE risk, pharmacological prophylaxis is necessary. Using low molecular weight heparin (LWMHs) is logical, because LWMHs remain the best-documented anticoagulant class in OP. Benefit of weight based dosing regimens for LMWH in VTE prevention is not proven for OP in ICU or in bariatric surgery. Pharmacodymanic approach using anti-Xa monitoring has not been studied in ICU OP. Mechanical methods, such as graduated compression stockings or intermittent pneumatic compression devices, have not been sufficiently studied but remain underused in potentially suitable patients.

In the absence of specific clinical trial about VTE prophylaxis in overweight patients, we suggest to follow the 9^th American College of Chest Physicians guidelines by using LWMHs with standard dose. The routine association of mechanical methods cannot be recommended.