Venous thromboembolism deserves your attention

The survey of how Canadian intensive care units (ICUs) prevent and diagnose venous thromboembolism (VTE) presented in this issue of Critical Care illustrates considerable variability. Lack of optimal patient care reflects how VTE is rated in ICUs. The discussion should no longer focus on the incidence of thrombosis, but rather on its prevention. Unfractionated heparin remains the most commonly used agent to prevent VTE, despite the recognized efficacy and safety of low-molecular-weight heparins (LMWHs) in the ICU setting. In addition, too few ICU directors consider the use of mechanical prophylactic measures, such as graded elastic stockings and venous foot pump. The present situation calls for large randomized controlled trials in either medical or surgical ICU patients, and for new education programmes in order to modify the care of ICU patients with regard to VTE.