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01-12-2013 | Original

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

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

Published in: Intensive Care Medicine | Issue 12/2013

Abstract

Purpose

Bleeding 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.

Methods

We 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.

Results

Among 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).

Conclusions

As 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.

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Title: Risk factors and impact of major bleeding in critically ill patients receiving heparin thromboprophylaxis
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
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3044-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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