Risk factors and impact of major bleeding in critically ill patients receiving heparin thromboprophylaxis View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-08-14

AUTHORS

François Lauzier, Donald M. Arnold, Christian Rabbat, Diane Heels-Ansdell, Ryan Zarychanski, Peter Dodek, Betty Jean Ashley, Martin Albert, Kosar Khwaja, Marlies Ostermann, Yoanna Skrobik, Robert Fowler, Lauralyn McIntyre, Joseph L. Nates, Tim Karachi, Renato D. Lopes, Nicole Zytaruk, Simon Finfer, Mark Crowther, Deborah Cook

ABSTRACT

PurposeBleeding frequently complicates critical illness and may have serious consequences. Our objectives are to describe the predictors of major bleeding and the association between bleeding and mortality in medical–surgical critically ill patients receiving heparin thromboprophylaxis.MethodsWe prospectively studied patients from 67 intensive care units and six countries enrolled in a thromboprophylaxis trial (NCT00182143) comparing dalteparin with unfractionated heparin. Patients with trauma, orthopedic surgery or neurosurgery were excluded. Trained research coordinators used a validated tool to document bleeding, which underwent duplicate independent blinded adjudication. Major bleeding was defined as hypovolemic shock, bleeding into critical sites, requiring an invasive intervention or transfusion of at least two units of red blood cells, or associated with hypotension or tachycardia in the absence of other causes. Adjusted Cox proportional hazard regression analysis was used to identify major bleeding predictors and the association between bleeding and mortality.ResultsAmong 3,746 patients, bleeding occurred in 208 [5.6 %, 95 % confidence interval (CI) 4.9–6.3 %]. Time-dependent predictors were prolonged activated partial thromboplastin time [hazard ratio (HR) 1.10, 1.05–1.14 per 10 s increase], lower platelet count (HR 1.16, 1.09–1.24 per 50 × 109/L decrease), therapeutic heparin (HR 3.26, 1.72–6.17), antiplatelet agents (HR 1.38, 1.02–1.88), renal replacement therapy (HR 1.75, 1.20–2.56), and recent surgery (HR 1.64, 1.01–2.65). Type of pharmacologic thromboprophylaxis was not associated with bleeding. Patients with bleeding had a higher risk of in-hospital death (HR 2.09, 1.69–2.57).ConclusionsAs major bleeding has modifiable risk factors and is associated with in-hospital mortality, strategies to mitigate these factors should be evaluated in critically ill patients. More... »

PAGES

2135-2143

Journal

TITLE

Intensive Care Medicine

ISSUE

12

VOLUME

39

Author Affiliations

  • Division of Critical Care, Departments of Medicine and of Anesthesiology, Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Université Laval, 1401, 18e Rue, G1J 1Z4, Québec, QC, Canada
  • Canadian Blood Services, Hamilton, ON, Canada
  • Department of Medicine, McMaster University, Hamilton, Canada
  • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
  • Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
  • Division of Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
  • Departments of Medicine and of Critical Care, Centre de recherche de l’Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
  • Departments of Surgery and of Critical Care, McGill University Health Centre, Montréal, QC, Canada
  • Department of Critical Care, King’s College London, Guy’s and St Thomas’ Foundation Hospital, London, UK
  • Lise and Jean Saine Critical Care Chair, Department of Medicine, Université de Montréal; Regroupement de Soins Critiques respiratoires, Réseau de Santé Respiratoire, Québec, Canada
  • Departments of Critical Care Medicine and of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
  • Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
  • Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  • Division of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC, USA
  • Department of Intensive Care, Royal North Shore Hospital and the George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-013-3044-3

    DOI

    http://dx.doi.org/10.1007/s00134-013-3044-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1036611640

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/23942857


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