Thrombelastogram Guide The Application Of LMWH In ICU Patients With Long-term Bedridden

Objective Studies have shown that about 10% of ICU patients have experienced multiple effects such as primary disease,neuroendocrine and immune function changes,and transited from acute critical illness to chronic critical illness to some extent.They rely on intensive care and require prolonged organ support and immobilization in bed.Long-term bed rest leads to the weakening of skeletal muscle pump function and the combined effect of microvascular and lymphatic system obstruction,and the risk of venous thromboembolism is also increasing.For long-term bed patients in ICU,empirical anticoagulant therapy of LMWH is often given to prevent the formation of VTE,but there is no scientific guidance.Long-term use is likely to cause bleeding reaction,and there are individual differences in the dose of LMWH,so it is necessary to adjust the dosage at any time in combination with laboratory monitoring results.As a coagulation guiding parameter,TEG has been rarely reported in the application of LMWH anticoagulant therapy in ICU patients with long-term bed rest.Therefore,it is assumed that whether the anticoagulant therapy with LMWH under the guidance of TEG has better advantages than the conventional coagulation function.Methods In this study,a randomized,prospective study program was adopted to select long-term bedrid patients who were treated in ICU of our hospital from February 2017 to May 2018 and met inclusion criteria and exclusion criteria.Then they were randomly divided into experimental group and control group.When TEG indicated high coagulation,low molecular heparin(LMWH)70U/kg was given,subcutaneously,once a day,until the TEG value was normal.The TEG changes were continuously monitored at 3 days,7 days,10 days and 14 days after the enrollment,and the heparin dosage was adjusted in time.The control group was given LMWH anticoagulant in accordance with the routine coagulation function,when the hypercoagulant state was indicated.The program was the same as the experimental group,and continuous monitoring was conducted for 2 weeks.The use time and dosage of LMWH,the incidence of adverse events,the number of DIC cases,the 28-day mortality rate and the length of stay in the ICU of the two groups were recorded,and the statistical differences between the two groups were finally compared.Results The starting time of LMWH in the experimental group was earlier than that in the control group(1.0 VS 2.5,P < 0.01).The treatment time of LMWH in the experimental group was shorter than that in the control group(9.00 3.21 VS 10.70 2.78,P < 0.05).The dose of LMWH in the experimental group was less than that in the control group(39655.00 14925.89 VS 47238.33 11392.76,P < 0.05).The incidence of DVT in the experimental group was lower than that in the control group(6.67 VS 26.67,P < 0.05).The diagnostic time of DVT in the experimental group was earlier than that in the control group(8.25 3.40 VS 11.73 2.15,P < 0.05).The incidence of VTE in the experimental group was lower than that in the control group(6.67 VS 33.33,P <0.05).The incidence of bleeding in the experimental group was lower than that in the control group(10 VS 33.33,P<0.05).The incidence of DIC in the experimental group was lower than that in the control group(6.67 VS 26.67,P<0.05).The 28-day mortality of the experimental group was lower than that of the control group(13.33 VS 36.67,P<0.05).The length of ICU stay in the experimental group was shorter than that in the control group(43.60 14.47 VS 53.30 19.18,P<0.05).Conclusions ICU patients with prolonged bed easily complicated by coagulation disorders,TEG can early,accurate and fast judgment high coagulation state,and to guide clinical LMWH anticoagulant therapy,and timely and proper amount of LMWH is helpful to reduce the ICU in long-term adverse events in patients with(thrombosis and hemorrhage),DIC incidence and mortality,28 days shorten ICU length of hospital stay,improve the prognosis of patients.