Management of venous thromboembolism in the intensive care unit Journal Article
| Author: | Pastores, S. M. |
| Article Title: | Management of venous thromboembolism in the intensive care unit |
| Abstract: | Venous thromboembolism, manifested as either deep venous thrombosis or pulmonary embolism (PE), is a major cause of morbidity and mortality in patients admitted to the intensive care unit. Clinically, PE may present as massive thromboembolism associated with cardiogenic shock or may be asymptomatic, as may occur with anatomically small emboli without hemodynamic or respiratory compromise. The management of venous thromboembolism in the critically ill patient can be exceedingly complex. The main treatment objectives are the prevention of recurrent PE and, in case of hemodynamic compromise, definitive therapy for deep venous thrombosis or PE involving removal of thrombus. Prevention of recurrent PE is accomplished with anticoagulation and/or placement of an inferior vena cava filter. Definitive therapy involves thrombolysis and surgical or catheter embolectomy. Fluid and vasoactive therapy with norepinephrine may be indicated for refractory hypotension in patients with massive PE. © 2009 Elsevier Inc. All rights reserved. |
| Keywords: | clinical feature; clinical trial; drug efficacy; drug safety; drug withdrawal; recommended drug dose; anemia; bleeding; fluid therapy; risk factors; tomography, x-ray computed; anticoagulant therapy; deep vein thrombosis; continuous infusion; risk factor; loading drug dose; intensive care; lung embolism; pulmonary embolism; hypotension; intensive care unit; intensive care units; thrombosis; heparin; recurrent disease; inferior cava vein; transesophageal echocardiography; drug contraindication; electrocardiography; hemodynamics; computed tomographic angiography; fibrinolytic agent; heparin induced thrombocytopenia; enoxaparin; fondaparinux; lepirudin; low molecular weight heparin; partial thromboplastin time; transthoracic echocardiography; hypertensive factor; noradrenalin; icu; massive pulmonary embolism; venous thromboembolism; alteplase; anticoagulant agent; apixaban; argatroban; d dimer; dalteparin; danaparoid; idraparinux; protamine sulfate; rivaroxaban; streptokinase; tenecteplase; tinzaparin; urokinase; classification algorithm; embolectomy; extracorporeal oxygenation; fibrinolytic therapy; multidetector computed tomography; vena cava filter; critical illness; vasoconstrictor agents; vena cava filters |
| Journal Title: | Journal of Critical Care |
| Volume: | 24 |
| Issue: | 2 |
| ISSN: | 0883-9441 |
| Publisher: | W.B. Saunders Co. |
| Date Published: | 2009-01-01 |
| Start Page: | 185 |
| End Page: | 191 |
| Language: | English |
| DOI: | 10.1016/j.jcrc.2009.03.004 |
| PUBMED: | 19501307 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "CODEN: JCCAE" - "Source: Scopus" |
