VTE Embolism

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Introduction: Pulmonary embolism is the most common preventable cause of hospital death and is the number one strategy to improve patient safety in hospital (Geerts et al., 2004). VTE is common among hospital inpatients and is encountered at least as frequently among medical as surgical patients (Bergmann and Kher 2005). Few studies had reported frequency of VTE in medical patients especially in ICU, although approximately 75% of fatal VTE occur among acutely ill non surgical patients (Bosker 2001, and Leizorovicz et al., 2004). VTE is contributing to approximately 10% of all hospital deaths and there is a varying reports of fatal VTE events in hospital ranging from 5-10% to 12-25% (Simonneau et al., 1997, Heit et al., 1999, and Cohen and Alikhan, 2001). Absolute DVT risk in hospitalized patients was 10-20% in medical patients and 10-80% in critical case patients (Greets et al ., 2004). In a review of 1231 patients treated for VTE, 96% had at least one recognized risk factor. Risk increased in proportion to the number of predisposing factors (Anderson and Spencer 2003). In ICU patients, risk factors for VTE include among others, illness requiring ICU, immobilization for at least three days, previous VTE, old age, cancer, CHF, and indwelling vascular catheters. All of these risk factors are present in acutely decompensated COPD patients (Leizorovicz and Mismetti 2004). There is a notable absence of guidelines for the prevention of VTE in such critically ill patients (Greets and Selby 2003). Many reports documented that thromboprophylaxis is underemployed in critically medical patients, in contrast to its practice among surgical wards (Campbell et al., 2001, Rahim et al., 2003 and Stark and Kilzer 2004). The importance o... ... middle of paper ... ...d patients compared to naïve group. There was non significant difference as regard duration of mechanical ventilation. Inhospital death rate was significantly lower in enoxaparin treated groups (tables 2, 3, 4 and 5). Bosson et al, 2003 found that thromboprophylaxis decreased significantly hospitalization period and in hospital death. They reported mortality rate to be 3.8% in patients with DVT and 38.9% in those with PE. In contrary death rate was non significantly different between patients with thromboprophylaxis and whose without difference in LOS (Gardund, 1996 and Bergmann and Kher 2005). From the previous results; it can be concluded that, thromboprophylaxis in acutely decompensated COPD patients admitted to ICU with standard prophylactic dose of enoxaparin is extremely advisable, screening for DVT using DUS is essential in such circumstances, and the fear
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