Risque des antithrombotiques en réanimation

Antithrombotic drugs prescription in the intensive care setting is associated with different types of risks. This is illustrated in three situations. The global strategy for prevention of the venous thromboembolic disease in the ICU setting is first discussed. The medical literature as well as the professional guidelines support a large prescription of antithrombotic therapy (using antithrombotic drugs and/or mechanical prophylaxis). In this setting, the major risk is probably the risk of under-utilisation. The 2nd example is related to the analysis of hemorrhagic complications. The authors stress the importance to obtain in the future a standardisation of the definitions of major hemorrhagic complications. This is illustrated by the example of a large series of massive pulmonary embolisms. Finally, the last example is related to the ways to optimise the management of a suspicion of a type II heparin-induced thrombocytopenia in the ICU setting. In conclusion, the authors suggest some directions for future clinical studies in this setting.