Venous thromboembolism prophylaxis in medical ICU patients in Asia (VOICE Asia): a multicenter, observational, cross-sectional study

Objectives: The VOICE Asia study aimed to establish the mode of thromboprophylaxis in medical patients admitted to intensive care units (ICU), and to describe the epidemiology of patients at high-risk of venous thromboembolism (VTE) and of patients who were prescribed low molecular weight heparin (LMWH).

Methods: This multinational, observational, cross-sectional study recruited medical patients admitted to ICU in whom a decision to give VTE prophylaxis had been taken. The treating physicians decided patient management. We recorded demographics, VTE risk factors, VTE risk assessment, thromboprophylaxis, and compliance to the American College of Chest Physicians (ACCP) guidelines.

Results: The study enrolled 2969 patients from 113 centers in 5 Asian countries. The most common VTE risk factors were age > 60 years (57.1%), prolonged immobility (50.6%), respiratory diseases (41.3%), and acute infectious disease (36.2%). There was a wide gap between physicians' assessment of 'very high' risk for VTE (8.4%) and Caprini 'very high' risk stratification (54.9%). 2919 (98.3%) patients received prophylaxis (22.9%-only mechanical, 31.2%-only pharmacological, 44.2%-both, mechanical and pharmacological and 1.7%- no prophylaxis). Early mobilization (44.3%) and LMWH (66.2%, mean duration of prophylaxis-8.6 days) were the most common mechanical and pharmacological prophylaxis, respectively. 80.6% of patients were given thromboprophylaxis as per the ACCP guidelines (and 4.7% per Japanese guidelines).

Conclusions: There is substantial underestimation of VTE risk and non-adherence to guidelines for thromboprophylaxis in medical ICU patients in participating Asian countries. This emphasizes the need for increasing awareness about optimum VTE risk assessment and improved implementation of appropriate thromboprophylaxis in at-risk medical ICU patients.