Three randomized thromboprophylaxis

PE is a common preventable cause of hospital death. The Agency for Healthcare Research and Quality has recently published a report entitled “Making Health Care Pharmacy online Safer: A Critical Analysis of Patient Safety Practices.” This systematic review ranked 79 patient safety interventions based on the strength of the evidence supporting more widespread implementation of these procedures. The highest ranked safety practice was the “appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk. ” This recommendation was based on overwhelming evidence that thromboprophylaxis reduces adverse patient outcomes while, at the same time, decreasing overall costs.  Read more about canadian viagra

We identified only three randomized thromboprophylaxis trialsin critical care patients that used routine screening with an objective diagnostic test for DVT. The trial reported by Cade > 20 years ago randomized 119 general ICU patients to treatment with either placebo or low-dose heparin (LDH), 5,000 U subcutaneously 12h. Serial fibrinogen leg scanning detected DVT in 29% and 13% of the placebo and LDH groups, respectively (relative risk reduction with LDH, 55%; p < 0.05). Rates of proximal DVT and bleeding were not reported. In the second prophylaxis trial, LDH was compared to placebo in patients admitted to a medical ICU. Serial Doppler ultrasonography detected DVT in 31% of the 390 control patients and 11% of the 401 patients who were administered LDH (relative risk reduction with LDH, 65%; p = 0.001). PE was found in 5% and 2% of placebo-treated and heparin-treated patients, respectively. Proximal DVT and bleeding rates were not reported.

In the most recent randomized trial, patients who were receiving mechanical ventilation for an exacerbation of COPD were assigned placebo or the low-molecular-weight heparin, nadroparin, until they were weaned from mechanical ventilation or for 21 days, whichever occurred sooner. After a mean prophylaxis duration of 12 days, contrast venography detected DVT in 28% of placebo-treated patients and in 15% of those receiving nadroparin (relative risk reduction with nadroparin, 45%; p = 0.045). Major bleeding occurred in 3% and 6% of the placebo and nadroparin groups, respectively (p = not significant).