Abstract | BACKGROUND: METHODS: In a multicenter, open-label, prospective cohort study of critically ill patients with severe acute or chronic renal insufficiency or dialysis receiving subcutaneous dalteparin 5,000 IU once daily, we estimated the prevalence of proximal DVT by screening compression venous ultrasound of the lower limbs within 48 hours of ICU admission. DVT incidence was assessed on twice-weekly ultrasound testing. We estimated the incidence of major and minor bleeding by daily clinical assessments. We used Cox proportional hazards regression to identify independent predictors of both DVT and major bleeding. RESULTS: Of 156 patients with a mean (standard deviation) creatinine clearance of 18.9 (6.5) ml/min, 18 had DVT or pulmonary embolism within 48 hours of ICU admission, died or were discharged before ultrasound testing - leaving 138 evaluable patients who received at least one dose of dalteparin. The median duration of dalteparin administration was 7 days (interquartile range, 4 to 12 days). DVT developed in seven patients (5.1%; 95% confidence interval, 2.5 to 10.1). The only independent risk factor for DVT was an elevated baseline Acute Physiology and Chronic Health Evaluation II score (hazard ratio for 10-point increase, 2.25; 95% confidence interval, 1.03 to 4.91). Major bleeding developed in 10 patients (7.2%; 95% confidence interval, 4.0 to 12.8), all with trough anti- activated factor X levels </= 0.18 IU/ml. Independent risk factors for major bleeding were aspirin use (hazard ratio, 6.30; 95% confidence interval, 1.35 to 29.4) and a high International Normalized Ratio (hazard ratio for 0.5-unit increase, 1.68; 95% confidence interval, 1.07 to 2.66). CONCLUSION:
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Authors | Deborah Cook, James Douketis, Maureen Meade, Gordon Guyatt, Nicole Zytaruk, John Granton, Yoanna Skrobik, Martin Albert, Robert Fowler, Paul Hebert, Guiseppe Pagliarello, Jan Friedrich, Andreas Freitag, Tim Karachi, Christian Rabbat, Diane Heels-Ansdell, William Geerts, Mark Crowther, Canadian Critical Care Trials Group |
Journal | Critical care (London, England)
(Crit Care)
Vol. 12
Issue 2
Pg. R32
( 2008)
ISSN: 1466-609X [Electronic] England |
PMID | 18315876
(Publication Type: Journal Article, Multicenter Study)
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Chemical References |
- Anticoagulants
- Dalteparin
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Topics |
- APACHE
- Aged
- Anticoagulants
(adverse effects, therapeutic use)
- Critical Illness
- Dalteparin
(adverse effects, therapeutic use)
- Female
- Hemorrhage
(chemically induced, epidemiology)
- Humans
- Incidence
- International Normalized Ratio
- Leg
(blood supply, diagnostic imaging)
- Male
- Prevalence
- Proportional Hazards Models
- Prospective Studies
- Pulmonary Embolism
(epidemiology, etiology)
- Renal Dialysis
- Renal Insufficiency
(complications)
- Risk Factors
- Ultrasonography
- Venous Thrombosis
(diagnostic imaging, epidemiology, etiology)
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