Профилактика венозного тромбоэмболизма в отделениях реанимации (обзор)

Venous thromboembolism (VTE) is the third most frequent cause of death from cardiovascular diseases after myocardial infarction and stroke and the most preventable cause of mortality. VTE is common and potentially life-threatening in patients admitted to ICU, even in spite of preventive care. The purpose of the review is to justify the necessity of preventive care for venous thromboembolism in ICU patients. From over 300 initially selected sources of literature databases (Scopus, Web of science, RSCI, etc.), 99 sources were chosen including 69 that were published during the last five years (2015-2020). The exclusion criteria included data of low informative value or disproven data. The review discusses VTE relevance, risk factors for its development, selection and scope of preventive care depending on the risk of thrombosis and hemorrhage, patient management in different clinical settings (impaired renal function, thrombocytopenia, heparin-induced thrombocytopenia, liver dysfunction, indications for installation of vena cava filter). In the world literature, however, there is yet no consensus on the matter under discussion that would have been based on meta-analyses or large randomized studies. No agreement has been reached either in respect of use of mechanical and combined prophylaxis of venous thromboses/PATE, application of ultrasound to detect asymptomatic thromboses. There are no studies on efficacy and safety of pharmacological prophylaxis of VTE in patients with significant hepatic impairment. The review describes that all patients admitted in ICU feature a high risk of VTE development. The scope of preventive care depends not only on VTE risk but also on the risk of a hemorrhage. To prevent the latter, low-molecular weight heparins should be used. For most cases, the choice of heparine dose depends on renal function. When there is a high risk of hemorrhage, mechanical preventive aids are applied.