Author(s): Afzal Azim
Background: Oral anticoagulants have been used for treatment and preventing recurrent thromboembolism in cardiac and orthopaedic cases. Evidence regarding the safety and efficacy of oral anticoagulants for DVT prophylaxis in critical care settings is lacking. We present, preliminary experience with acenocoumarol (acitrom) in patients requiring prolonged mechanical ventilation. Patients & Methods: 45 neurological patients requiring prolonged mechanical ventilation were included out of which only 39 could be analyzed. All underwent DVT probability risk assessment and received low molecular weight heparin along with acitrom 2mg day-1 for five days, followed by dosing adjustments until international normalized ratio (INR) of 2-3 was achieved. After achieving the INR, heparin was stopped and patients were maintained on acitrom only. Therapy was monitored with INR, bleeding complications and lower limbs Doppler. Results: Mean duration of mechanical ventilation and ICU stay was 38.57±9.23 and 47.73±16.22 days respectively. None of our patient had any complication related to acitrom therapy or any evidence of symptomatic or asymptomatic (Doppler) deep vein thrombosis during ICU stay or during follow-up of 3 months. The cost of Acitrom including the cost of INR monitoring was only 330 Indian rupees (INR) for a thirty day therapy. Conclusion: In this short case series, acitrom appears to be a suitable alternative to other available therapies for the prevention of DVT atleast in this particular subgroup of critically ill patients. However due to the small sample size we feel that a larger randomized trial is needed to come to a definite conclusion.