Thrombosis in the intensive care unit: etiology, diagnosis, management, and prevention in adults and children

Venous thromboembolism, a well-recognized complication in postoperative patients, is emerging as a frequent complication in critically ill patients in intensive care units. Diagnosis can be particularly difficult in such patients because underlying systemic illnesses may mask common presenting signs and symptoms. Although numerous independent risk factors have been identified, the critical role of both central venous catheters and prothrombotic disorders as significant risk factors is a common theme in the pediatric and adult literature. Various diagnostic tests exist, with venography remaining the gold standard and newer, less invasive methods such as ultrasonography and impedance plethysmography becoming increasingly popular. Standard unfractionated heparin remains the mainstay of therapy and prophylaxis, although the use of low molecular weight heparins is becoming more commonplace. Thrombolytic therapy continues to be reserved for severe, life-threatening, acute thrombosis. In this article, we review the common risk factors, diagnostic modalities, and treatment options for venous thromboembolism in critically ill adult and pediatric patients.