Tóm tắt Luận án Study the risk factors for lower extremity deep vein thrombosis in the first time and the results of prevention by low molecular weight heparin in the emergency resusciation pateint

iagnostic value of 96% (99% if D dimer also negative). Positive diagnosis in high-risk patients (Well’s score ≥ 2) is less than 75%, other tests are needed to diagnose acute DVT. - D-Dimer test for DVT: D-Dimer is a fibrin degradation product during blood coagulation, has high sensitivity, low specificity, so it has a diagnostic value to exclude DVT when D-Dimer is negative, when positive D-Dimer does not necessarily mean blood clots. - Pressed venous Doppler ultrasound is a non-invasive, less expensive, portable, made in bed, repetitive and non-toxic method for both physicians and patients more than other methods. Symptomatic patients, Doppler ultrasound diagnoses DVT have 95% sensitivity and 98% specificity. Asymptomatic patients had a sensitivity of 54%, specificity 91%, positive predictive value 83%, negative predictive value 69%. 1.6. Prophylaxis of DVT in patients with ER Venous thrombosis prophylaxis has been proven effectively, prophylaxis reduces morbidity, reduces costs and reduces mortality. As recommended by ACCP (2012), in 2017, the Vietnam National Association of Emergency, Intensive Care Medicine provided guidelines for uniform treatment of VT prophylaxis in ICU patients by following these steps: Step 1: Assess the risk of VT in patients with hospitalization based on the underlying risk factors and the patient's medical condition. Step 2: Assess the risk of bleeding, the contraindications of anticoagulant treatment. Step 3: Summarize the risks, weigh the benefits of prevention and the risk of bleeding when using anticoagulants, paying special attention to renal function, elderly patients. Step 4: Select the appropriate backup method and time. The risk of VT and the risk of bleeding may vary daily for each patient. Follow a unified regimen - Name of medicine: Low TLH heparin, brand-name drug: Lovenox of Sanofi-Aventis Vietnam Company. - Dosage: 40mg (4,000 anti-Xa units, 0.4 ml), 1 time / day - Administration: Subcutaneous injection once daily, starting within 24 hours after the patient is admitted to the hospital and is indicated for prophylaxis. Duration of use: 10 ± 4 days Chapter 2 SUBJECTS AND METHODS 2.1. Subjects 2.1.1. Inclusion criteria: when the patient meets the following criteria: - Over 18 year - old, eligible for treatment at ICU - APACHE II score> 18 - Expected treatment ≥ 6 days (maximum 30 days) - Patient or family member agrees to participate in the study 2.1.2. Exclusion criteria: The patient is having DVT The patient is being treated for anticoagulant Patients with coagulation disorders or blood diseases Patients with contraindications to taking anticoagulants Patient or family member do not agrees to continue the research The patient lost data. 2.2. Methods: In cohort studies, all patients who met the criteria were conducted according to the agreed steps. 2.2.1. Setting: Patients who were eligible for inclusion in the study, noted the risk factors, risk stratification according to Padua Prediction Score, deep vein Doppler ultrasound with posterior compression at 7 days post-hospitalization, if DVT, discontinue study and treat DVT by regimen. Patients without DVT continued to monitor and record risk factors, Doppler ultrasound deep vein in the lower extremities was hospitalized for 14 days, 21 days and ended the study after 30 days. At the end of the study conducted analysis according to the objectives. Figure 2.1. Research scheme 2.2.2. Study sample size: Based on the formula for calculating sample size with comparison between prophylactic and non-prophylactic treatment (calculating sample size for 2 rates), currently there has been no announcement of DVT prophylaxis in medical ICU patients. MEDENOX study has many similarities with this study, so we based on the proportion of DVT in the non-prophylactic and preventive treatment group in the MEDENOX study was 14.9% and 5.5 %, estimated sample size (N) is: = = Inside: - p1 is the incidence of DVT in the non-prophylactic group = 14.9% - p2 is the incidence of DVT in the preventive treatment group = 5.5% - n1 is the sample size of the group without preventive treatment - n2 is the sample size of prophylactic treatment group Sample size needed for each group: n1 = n2 = 162 patients The total sample size of the 2 groups at least is: N = 324 patients 2.2.3. Procedures and techniques in research Identify common VT risk factors Determining history of acute medical diseases and diseases Identify VT risk factors in ICU Diagnosis of lower extremity DVT: by an ultrasound Doppler ultrasound procedure of the lower extremity is performed by a qualified diagnostic imaging doctor. During the follow-up process, in case of suspected postgraduate students, the image diagnosis doctor will check again. Tests, image diagnostics Prophylaxis of lower extremity DVT by low molecular weight heparin according to the uniform regimen Table 1.1. Padua Prediction Score Risk factors Active cancer Previous VTE(except superficial thrombosis) Bedrest> = 3 days Thrombophilia Recent trauma and / or surgery (<= 1 month) Elderly age > = 70 Heart failure and / or respiratory failure Acute myocardial infarction or ischemic stroke Acute infection and / or rheumatologic disorder Obesity (BMI> = 30 kg/m2) Ongoing hormonal treatment Score 3 3 3 3 2 1 1 1 1 1 1 * Patients with metastases near or far and / or undergoing chemotherapy or radiation within 6 months ** Defect antithrombin, S protein, C protein, V Leiden factor, prothrombin mutation G20210A, antiphospholipid syndrome Total score <4: Low risk of VT → No need for prophylaxis Total score ≥ 4: High risk of VT → Need preventive treatment 2.2.4. Research indicators 2.2.4.1. Target research objective 1 Some risk factors for lower extremity DVT in internal ICU patients Incidence of lower extremity DVT in internal ICU patients 2.2.4.2. Target research objective 2 Prophylaxis of DVT prophylaxis with Enoxaparin in ICU patients in the Bach Mai hospital and the Friendship hospital. 2.2.5. Data processing Information collected from research records is entered into computers and analyzed and processed on SPSS software version 21.0. Research risk factors of lower extremity DVT by logistic regression model. First, univariate analysis processed by groups of patients with or without DVT in the sample of the study population, then multivariate regression analysis by Cox regression method. 2.2.6. Medical ethics The study was approved and approved by the Board of Research Approving Council of Hanoi Medical University in 2014. This is a descriptive observational study, not affecting patients. The research process did not delay or affect the patient's treatment process. Tests and diagnostic measures are carried out exactly as directed and for the benefit of the patient. Participants in the study did not have to pay for ultrasound of DVT screening and testing costs during the hospital stay Research is only for the protection and improvement of patient health care, not for any other purpose. Chapter 3 RESULTS Through study of 354 patients, we recorded the following characteristics: 3.1. Characteristics of researched patient group 3.1.1 Characteristics of research group with qualitative variables Table 3.1. Characteristics of research group with qualitative variables Characteristics Samples N (%) PREVENTION p Yes n1 (%) No n2 (%) Gender Male Female 266 (75.1) 88 (24.9) 122 (45.9) 49 (55.7) 144 (54.1) 39 (44.3) 0.11 Cancer 38 (10.7) 13 (34.2) 25 (65.8) 0.066 Exacerbation of COPD 40 (11.3) 19 (47.5) 21 (52.5) 0.914 Heart failure 86 (24.3) 33 (38.4) 53 (61.6) 0.034 Infection 284 (80.2) 135 (47.5) 149 (52.5) 0.559 Pancreatitis 26 (7.3) 11 (48.3) 15 (57.7) 0.525 Comatose 34 (9.6) 11 (32.4) 23 (67.6) 0.050 Respiratory failure 220 (62.1) 104 (47.3) 116 (52.7) 0.618 High blood pressure 187 (52.8) 82 (43.8) 105 (56.2) 0.076 Diabetes 80 (22.6) 40 (50.0) 40 (50.0) 0.730 Acute cerebral infarction 39 (11.0) 19 (48.7) 20 (51.3) 0.830 Use sedatives 59 (16.7) 28 (47.5) 31 (52.5) 0.887 Use vasomotor medication 107 (30.2) 43 (40.2) 64 (59.8) 0.044 Breathing machine 155 (43.8) 78 (50.3) 77 (19.7) 0.549 3.1.2 Characteristics of patients group studied with quantitative variables Table 3.2. Characteristics of patients group studied with quantitative variables Characteristics Samples N (%) PREVENTION p Yes n1 (%) No n2 (%) Average age of patient Friendship hospital (years) 80.2 ± 8.8 (35 - 99) 79.5 ± 8.5 (50 - 94) 80.5 ± 9.0 (35 - 99) 0.34 Average age of patient Bach Mai hospital (years) 57.9 ± 17.9 (18 - 97) 59.4 ± 18.6 (18 - 97) 55.1 ± 16.4 (19 - 83) 0.14 Hight (cm) 163.7 ± 5.1 (144.0 - 175.0) 163.9 ± 5.4 (144.0 - 175.0) 163.6 ± 4.8 (146.0 - 175.0) 0.700 Weight (kg) 55.5 ± 6.8 (37.0 - 88.0) 56.2 ± 7.5 (37.0 - 88.0) 54.9 ± 6.1 (39.0 - 78.0) 0.074 BMI (kg/m2) ± SD 20.7 ± 2.3 (13.5 - 30.5) 20.9 ± 2.4 (13.6 - 30.4) 20.5 ± 2.2 (15.4 - 30.5) 0.108 Leukocytes (G/l) 14.14 ± 8.66 14.33 ± 10.20 13.96 ± 6.92 0.695 Platelets (G/l) 210.9±146.76 204.3 ± 113.9 217.1 ± 172.2 0.418 PT (giây) 16.97 ± 11.68 16.13 ± 7.49 17.76 ± 14.53 0.206 PT% (%) 74.57 ± 24.39 74.11 ± 24.84 74.99 ± 24.03 0.744 INR 1.66 ± 7.29 2.05 ± 10.47 1.30 ± 0.44 0.347 aPTT (giây) 35.85 ± 23.33 36.26 ± 30.07 35.42 ± 13.15 0.763 Fibrinogen (g/l) 4.7 ± 4.3 5.05 ± 5.97 4.37 ± 1.56 0.159 D-dimer BMH 74.77 ± 597.37 61.15 ± 545.67 99.44 ± 686.10 0.709 Median 3.77 3.94 3.46 0.942 5% - 95% 0.62 - 14.67 0.56 - 14.22 0.94 - 15.56 FH 289.88 ± 956.63 438.46 ± 1333.0 216.40 ± 698.23 0.204 Median 3.12 3.52 2.5 0.012 5% - 95% 0.75 - 2030 0.96 - 5000 0.73 - 1750 3.2. Risk factors for lower extremity DVT in the study population 3.2.1. Risk factors are exposed Table 3.3. The proportion of risk factors being exposed Risk factors are exposed Number of patients Rate (%) Acute cerebral infarction 39 11.02 Exacerbation of COPD 40 11.3 Respiratory failure 220 62.15 Infection 284 80.23 Digestive diseases 26 7.34 Motionless before entering the ICU 111 31.36 Central venous catheter 269 75.99 Use sedatives 59 16.67 Use vasomotor medication 107 30.23 Breathing machine 155 43.79 Total 354 100.0 3.2.2. Risk factors Table 3.4. The rate of risk factors Risk factors Number of patients Rate (%) Cancer 38 10.7 Nephrotic syndrome 30 8.5 High blood pressure 187 52.8 Diabetes 80 22.6 Smoking 184 52.0 Age> 60 252 71.2 BMI> 23 43 12.1 Pregnant 14 3.9 History of DVT 1 0.3 3.2.3. Percentage of patients following the predicted risk DVT according PADUA Prediction Score Table 3.5. Percentage of patients following the predicted risk DVT according Padua Prediction Score Number of risk factors Number of patients n % 0 4 1.1 1 46 13.0 2 110 31.1 3 124 35.0 4 64 18.1 ≥ 5 6 1.7 Total 354 100.0 3.2.4. Padua cutoff point in the research Table 3.6. Padua cut off point in the research PADUA score DVT n(%) None DVT n(%) p OR(95%CI) ≥ 3 71 (33.2) 143 (66.8) 0.037 1,68 (1,03-2,73) < 3 32 (22.9) 108 (77.1) Sensitivity = 68.9; Specificity = 43. ≥ 4 54 (37.2) 91 (62.8) 0.005 1,94 (1,22-3,08) < 4 49 (23.4) 160 (76.6) Sensitivity = 52.4; Specificity = 63.7 ≥ 5 47 (38.5) 75 (61.5) 0.005 1,97 (1,23-3,16) < 5 56 (24.1) 176 (75.9) Sensitivity = 45.6; Specificity = 70.1 - The cut-off point of Padua <4 & ≥ 4 is suitable for the sensitivity of 52.4%, specificity 63.7%, p = 0.005 3.2.5. Multivariate regression analysis of risk factors and lower extremity DVT 3.2.5.1. Univariate regression analysis Table 3.7. Univariate regression analysis of risk factors and lower extremity DVT Factors LEDVT None LEDVT OR(95%CI) p n % n % Age > 60 85 33.7 167 66.3 2.37 (1.33 - 4.24) 0.003 ≤ 60 15 17.6 84 82.4 Gender Male 87 32.7 179 67.3 2.2 (1.2 - 4.0) 0.009 Female 16 18.2 72 81.8 Smoking Yes 72 39.1 112 60.9 2.88 (1.7 - 4.8) <0.001 No 1 18.2 139 81.8 Heart failure Yes 40 46.5 46 53.5 2.82 (1.68 - 4.77) <0.001 No 63 23.1 205 76.5 Respiratory failure Yes 70 33.2 147 66.8 1.7 (1.1-2.8) 0.03 No 30 22.4 104 77.6 Cancer Yes 17 44.7 21 55.3 2.2 (1.1-4.3) 0.025 No 86 27.2 230 72.8 Padua ≥ 4 54 37.24 91 62.76 1.94 (1.21-3.10) 0.005 < 4 49 23.44 160 76.56 Ventilator Yes 73 33.2 147 66.8 1.72 (1.04 - 2.83) 0.03 No 30 22.4 104 77,6 3.2.5.2. Multivariate regression analysis Table 3.8. Multivariate regression analysis of risk factors and lower extremity DVT Factors OR (95% CI) p Age > 60 1.64 (0.85 - 3.18) 0.141 Gender 1.02 (0.46 - 2.26) 0.957 Smoking 2.57 (1.32 - 5.01) 0.006 Heart failure 2.92 (1.63 - 5.23) <0.001 Respiratory failure 1.43 (0.71 - 2.86) 0.315 Cancer 1.37 (0.58 - 3.27) 0.474 Pardua (≥ 4) 2.72 (1.13 - 6.58) 0.026 Ventilator 1.31 (0.69 - 2.51) 0.411 Table 3.9. Multivariate regression analysis of risk factors over time Factors 7th day 14th day 21 th day HR(95%CI) p HR (95%CI) p HR (95%CI) p Age> 60 1.868 (0.97-3.61) 0.063 1.934 (1.09-3.45) 0.025 1.902 (1.07-3.39) 0.029 Gender 1.551 (0.70-3.43) 0.279 1.062 (0.54-2.09) 0.863 1.061 (0.54-2.09) 0.864 Smoking 1.262 (0.69-2.31) 0.451 1.578 (0.90-2.78) 0.114 1.614 (0.92-2.84) 0.097 Heart failure 0.527 (0.25-1.12) 0.094 0.429 (0.21-0.86) 0.018 0.480 (0.25-0.94) 0.032 Respiratory failure 1.294 (0.70-2.41) 0.416 1.350 (0.78-2.35) 0.289 1.287 (0.74-2.23) 0.368 Cancer 1.148 (0.60-2.19) 0.674 1.129 (0.62-2.04) 0.689 1.212 (0.68-2.16) 0.513 Pardua (≥ 4) 1.751 (1.07-2.86) 0.025 1.575 (1.02-2.44) 0.041 1.598 (1.03-2.47) 0.035 Ventilator 1.036 (0.58-1.84) 0.904 0.994 (0.60-1.66) 0.982 1.004 (0.60-1.67) 0.989 Table 3.9. Multivariate regression analysis of risk factors in the prophylaxis group and no prophylaxis group. Factors OR (95% CI) p1* p2** Prophylaxis No prophylaxis Age> 60 2,82 (0,75 - 10,62) 2,50 (0,98 - 6,38) 0,125 0,045 Gender 0,97 (0,31 - 3,08) 1,35 (0,42 - 4,40) 0,96 0,613 Smoking 0,48 (0,14 - 1,61) 5,33 (2,07 - 13,75) 0,235 0,001 Heart failure 0,3 (0,07 - 1,24) 0,23 (0,08 - 0,62) 0,097 0,004 Respiratory failure 2,29 (0,54 - 9,78) 1,14 (0,47 - 2,72) 0,26 0,773 Cancer 0,48 (0,07 - 3,30) 1,40 (0,48 - 4,10) 0,456 0,535 Pardua ≥ 4 6,31 (1,20 - 33,08) 4,09 (1,18 - 14,21) 0,029 0,026 Motionless 0,71 (0,15 - 3,43) 0,23 (0,06 - 0,85) 0,676 0,028 Ventilator 0,63 (0,16 - 2,48) 1,92 (0,81 - 4,57) 0,510 0,138 p1*: prophylaxis group; p2**: No prophylaxis group 3.3. Efficacy of prophylaxis of lower extremity DVT with Enoxaparin 3.3.1. Incidence lower extremity DVT rate Table 3.10. Incidence lower extremity DVT rate and prevention Prevention Number of patients N (%) LEDVT n(%) None LEDVT n(%) p RR (95%CI) Yes 171 (48.3) 23 (13.4) 148 (86.6) < 0.001 0.38 (0.26 - 0.55) No 183 (51.7) 80 (43.7) 103 (56.3) Total 354 (100.0) 103 (29.1) 251 (70.9) The incidence of LEDVT newly acquired in the prophylactic group is lower than the non-prophylactic group, the difference is statistically significant. 3.3.2. Time detection and prevention LEDVT Table 3.11. Time detection and prevention LEDVT Time detection LEDVT Patient LEDVT (n=103) Prevention p Yes n(%) No n(%) After 7th days 83 18 (21.7) 65 (78.3) <0.001 After 14 days 19 4 (21.1) 15 (78.9) <0.001 After 21 days 1 0 (0.0) 1 (100.0) - After 28 days 0 0 (0.0) 0 (0.0) 3.3.3 Mortality from all causes and prevention of lower extremity DVT Table 3.12. The relationship between mortality and prevention Prevention Number of patients N(%) Death n (%) No death n (%) p OR (95%CI) Yes 171 (48.3) 10 (5.9) 161 (94.1) 0.002 0.49 (0.28-0.84) No 183 (51.7) 30 (16.4) 153 (83.6) Total 354 (100.0) 40 (11.3) 314 (8.7) - Mortality rate in the prophylactic group is lower than the non-prophylactic group, the difference is statistically significant. Table 3.13. Mortality rate in patients with LEDVT and non-LEDVT patients Patient Mortality p OR Yes n (%) No n (%) LEDVT 17 (16.5) 86 (83.5) 0.048 1.96 (0.93 - 4.03) Non-LEDVT 23 (9.16) 228 (90.84) Total 40 (11.3) 314 (88.70) - Mortality rate in the group with LEDVT is higher than the group without LEDVT, the difference is statistically significant. 3.3.4. Safety of prophylactic LEDVT by Enoxaparin Table 3.14. Proportion of patients with thrombocytopenia and prophylaxis Prevention Number of patients Thrombocytopenia n (%) No thrombocytopenia n (%) p OR (95%CI) Yes 171 (48.3) 13 (7.6) 158 (92.4) 0.836 0.96 (0.63 - 1.45) No 183 (51.7) 15 (8.2) 168 (91.8) Total 354 (100.0) 28 (7.9) 326 (92.1) - The rate of thrombocytopenia in the prophylactic group is lower than the non-prophylactic group, the difference is not statistically significant. - There were no cases of severe hemorrhage in the study Table 3.15. Proportion of patients changing creatinine with prophylaxis Prevention Patients N (%) Creatinin (≥ 120) n (%) Creatinin (<120) n (%) p RR (95%CI) Yes 171 (48.3) 12 (7.0) 159 (93.0) 0.54 1.14 (0.77-1.69) No 183 (51.7) 10(5.5) 173 (94.5) Total 354 (100.0) 21 (5.9) 333 (94.1) - The proportion of patients with creatinine blood > 120 in the prophylactic group is higher than the non-prophylactic group, the difference is not statistically significant. Chapter 4 DISCUSSION During the study of DVT prophylaxis in ICU patients was uneven and unified. Only in July 2017, the Vietnam National Associated Emergency, Intensive Care Medicine and Clinical Toxicology guidelines for prophylaxis of DVT in patients with intensive care. Therefore, out of 354 patients eligible for inclusion in the study, there was a group of patients with DVT prophylaxis (171 patients, 48.3%) and a group of patients who did not prevent DVT (183 patients, 51.7 %). 4.1. Characteristics of researched patient group 4.1.1. Characteristics of patients group studied with qualitative variables The ratio of qualitative variables between the prophylactic and non-prophylactic groups was similar (p> 0.05). The group of infected patient accounts for a high proportion (80.2%), respiratory failure 62.1%, and hypertension 52.8%, and mechanical ventilation 43.8%. This result is equivalent to the authors in the country, higher than foreign authors. 4.1.2. Characteristics of patients group studied with quantitative variables There was no statistically significant difference in the mean of quantitative variables between the prophylactic and non-prophylactic groups (p > 0.05). The average age of patients in the study was 69.1 ± 17.9 years, equivalent to the age in the studies of domestic and foreign authors. The average age of patients studied at the Bach Mai hospital was 57.9 ± 17.9 years, lower than the average age of patients studied at the Friendship hospital was 80.2 ± 8.8 years, due to almost patients at the Friendship Hospital are older people. The average body mass index of the sample is 20.7 ± 2.3 kg/m2, which is consistent with the average body mass index of hospitalized patients in Vietnam. According to the World Health Organization, a nutrition classification for Asians, this study included 12.15% of obese patients. The proportion of obese patients had no difference between the prophylactic and non-prophylaxis groups. The proportion of obese patients in the study is lower than other domestic and foreign studies. It is possible that the age of patients in the sample is elderly Vietnamese people, due to race. Domestically, the obesity rate in the study of Pham Anh Tuan is 22.4%. In Western countries, the rate of obesity in the study of the author Samama M: 19.6%, the author Lazoroviz: 30.6%. 4.2. Risk factors for LEDVT in the study population 4.2.1. Risk factors for LEDVT - The proportion of patients with LEDVT in the infection group (30.28%) was higher than the non-infected group (24.28%), but there was no difference. - The proportion of patients with LEDVT in the respiratory failure group is higher than the non-respiratory group and this difference is statistically significant with p = 0.03. - The rate of patients with heart failure in the group of LEDVT was higher than that of the group without the LEDVT, this difference was statistically significant with p = 0.001. - The percentage of patients with LEDVT in the cancer group is significantly higher than the non-cancer group with p = 0.025. - In the study, the number of mechanical ventilation patients in the group of patients with LEDVT was higher than the number of patients without LEDVT, the difference was statistically significant with p = 0.003. - Patients with LEDVT in patients with COPD exacerbations were higher than in patients without COPD exacerbations, but this difference was not statistically significant. - The proportion of patients with LEDVT in the catheter group is higher than the number of patients in the non-catheter group, but this difference is not statistically significant. - The rate of patients with LEDVT in the sedative group was 1.3 times higher than the group in the non-sedative group, but this difference was not statistically significant. -The proportion of patients with LEDVT in the group that used vasopressors was 1.36 times higher than the group without vasomotor drugs, but the difference was not statistically significant. - The percentage of patients with LEDVT in the 2 groups of cerebral infarction and non-cerebral infarction was no difference. - In the study, we did not recognize the relationship between hematological parameters, basic blood coagulation function and LEDVT. 4.2.2. Relationship between PADUA prediction core and LEDVT The percentage of patients with LEDVT in the group with Padua prediction score ≥4 is higher than the group with the Padua prediction score <4, the difference is statistically significant with p = 0.005 When analyzing 3 cutting points with Padua score (≥3 and < 3), (≥4 and <4), (≥5 and <5) the difference in the prevalence of LEDVT is significant, but with the Padua score cut (≥4 and <4) it showed that the sensitivity and specificity are relatively similar. 4.2.3. Multivariate regression analysis of the risk of LEDVT Through multivariate regression analysis, the univariate risk in the study showed that the Padua prediction score ≥ 4 has significant predictive of LEDVT, smokers, patients with heart failure are independent risk factors for LEDVT in patients with ICU. Through multivariate regression analysis over time, we found that the Padua prediction score ≥ 4 has significant predictive of LEDVT at all 3 points, age of patients > 60 years, heart failure is the independent risk factors for LEDVT after 14 days and after 21 days in ICU. Through multivariate regression analysis in the prophylaxis group and no prophylaxis group, we found that the Padua prediction score ≥ 4 has significant predictive of LEDVT for both of them, age of patients > 60 years, heart failure. smoking anh motionless is the independent risk factors for LEDVT in no prophylaxis group in ICU. 4.3. Efficacy of preventive treatment of LEDVT with Enoxaparin 4.3.1. The neww incidence LEDVT rate The prevalence of LEDVT in prevention group was 13.4% and in non-preventive groups was 43.7%, this difference was statistically significant (p <0.001). This rate is higher than the results of Western studies such as MEDENOX 5.5, PREVENT 2.8, ARTEMIS 5.6%, lower than Kaplan (2015), 113 In severe infections and septic shock patients at the Department of Gastroenterology, all prophylactic treatment showed a 37.2% prevalence of MS. Fraisse (2000) studied 223 patients with COPD exacerbations in France that showed the incidence in patients with prophylaxis was 15.5%. Thus, the prophylaxis of the LEDVT in patients with LEDVT reduces the incidence of newly acquired DVT compared to no prophylaxis. The results of our study are similar to those of prophylactic studies in patients in the West, with prophylaxis reducing the incidence of new infections compared with no prophylaxis. The incidence of LEDVT varies due to different patients, patients with many different diseases, different study time. 4.3.2. Time detection and prevention LEDVT The prevalence of LEDVT primarily occurred in the first 7 days of hospital admission, 83/103 patients (80.58%), the rate of LEDVT in the prophylactic group was lower than the non-prophylactic group with statistically significant (p <0.001). After 14 days of admission, there were 19/103 more patients with LEDVT (18.45%), prophylactic pa