Delving into DVT prophylaxis in critically ill patients, the podcast covers risks, medications like Fonda and heparin, challenges with warfarin therapy, and optimizing dosing with options like Lovanox and Heparin. Exploring procedures, anticoagulation timing, and personalized approaches for trauma and stroke cases. Highlighting chemoprophylactic agents, SCDs, and managing DVT prophylaxis in special cases like HIT and TTPHUS patients.
Platelet count below 50 increases bleeding risk, not protecting from DVT, requires individual assessment.
Daily DVT prophylaxis crucial in ICU, timely initiation emphasized by experts.
Combined mechanical and pharmacologic thromboprophylaxis reduces VTE risk by 60%, LMWH preferred over UFH.
Deep dives
Importance of Platelet Count in DBT Prophylaxis
Having a platelet count below 50 significantly increases the risk of bleeding. Platelet count below 50 is often mistakenly believed to protect from DBT. Patients need individual assessment, considering comorbidities like obesity and limited mobility.
DBT Prophylaxis in ICU and Expert Input
In the ICU, daily DBT prophylaxis is essential but often overlooked. Experts emphasize the importance of timely initiation of prophylaxis. Hematology and oncology specialists provide valuable insights into DBT prophylaxis strategies.
Efficacy of Thromboprophylaxis in ICU Patients
Studies show that combined mechanical and pharmacologic thromboprophylaxis reduces VTE risk by around 60%. Low molecular weight heparin is preferred over unfractionated heparin for prophylaxis. Tag can be used for additional information in specific cases.
DBT Prophylaxis Challenges in Specific Patient Cases
Challenges arise in complex patient cases like trauma, COVID-19 ARDS, or patients with TTP-HUS. Thromboprophylaxis should be carefully tailored based on individual risk assessments and clinical conditions. Special considerations apply to patients with thrombocytosis and thrombocytopenia.
Special Considerations in Liver Disease and Thrombocytosis
Patients with liver disease present unique challenges for DBT prophylaxis due to altered coagulation states. Thrombocytosis can increase thrombotic risk, while thrombocytopenia needs careful assessment for heparin-induced thrombocytopenia. Individualized approaches are crucial in managing thrombotic and bleeding risks.
Every time we admit or care for a critically ill patient, we must consider their risk for deep venous thrombosis, or DVT. Many of our patients are at higher risk for DVT than the general population, but anticoagulants are not wholly benign drugs. What do we do? How do we decide who to treat medically, who to treat with mechanical compressive devices and identify patients who may NOT need anything? When do risks outweigh benefits? What agent is best?
Join Nick and Cyrus as they interview hematologist & oncologist Dr. Matthew Rendo (Twitter/X: Rendoncology) as they do a deep dive into managing DVT prophylaxis in the critically ill patient!