Intensive Care Network Podcasts

Venous thromboembolism (VTE) is one of the most preventable complications in hospitalised patients. Critically ill patients are at risk of VTE due to coexisting of multiple risk factors but, at the same time, often at risk of bleeding. Though not common, fatal pulmonary embolism (PE) continues to occur [1] – due to the alignment of failures (or ‘holes’) in each defensive layer according to the Swiss cheese model [2]. Tackling this is not easy because the pattern of the ‘holes’ in each layer of the cheese is different between patients and, to complicate the matter further, both the size and location of the ‘holes’ also change with time in each individual patient.  In brief, fatal PE occurs due to one of the three failures – failure to prevent, failure to diagnose and failure to treat (aggressively). It is well established that anticoagulants are very effective in reducing VTE. The golden rule to reduce the size of the ‘holes’ in prevention is to use a multimodal approach, with anticoagulants as a key player