Mortality data from omission of early thromboprophylaxis in critically ill patients highlights the importance of an individualised diagnosis-related approach

Thrombosis Journal

Research

Karlheinz Peter¹  James D. McFadyen²  Edward Litton³  David Pilcher⁴  Berhe W. Sahle⁵  Tracey Bucknall⁶ 

[1] Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia;Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia;Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia;Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia;Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia;Department of Clinical Hematology, The Alfred Hospital, Melbourne, VIC, Australia;Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia;Fiona Stanley Hospital, Perth, WA, Australia;The University of Western Australia, Perth, WA, Australia;Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia;School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia;School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, VIC, Australia;Centre for Quality and Patient Safety Research, Alfred Health Partnership, Institute for Health Transformation, Melbourne, VIC, Australia;School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, VIC, Australia;Centre for Quality and Patient Safety Research, Alfred Health Partnership, Institute for Health Transformation, Melbourne, VIC, Australia;School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;

关键词: Venous thromboembolism;    VTE;    Thromboprophylaxis;    Intensive care unit;    Critically ill;    Mortality;   

DOI  :  10.1186/s12959-023-00499-y

 received in 2023-02-07, accepted in 2023-05-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundVenous thromboembolism (VTE) prophylaxis is effective in reducing VTE events, however, its impact on mortality is unclear. We examined the association between omission of VTE prophylaxis within the first 24 h after intensive care unit (ICU) admission and hospital mortality.MethodsRetrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for adult admissions between 2009 and 2020. Mixed effects logistic regression models were used to evaluate the association between omission of early VTE prophylaxis and hospital mortality.ResultsOf the 1,465,020 ICU admissions, 107,486 (7.3%) did not receive any form of VTE prophylaxis within the first 24 h after ICU admission without documented contraindication. Omission of early VTE prophylaxis was independently associated with 35% increased odds of in-hospital mortality (odds ratios (OR): 1.35; 95% CI: 1.31–1.41). The associations between omission of early VTE prophylaxis and mortality varied by admission diagnosis. In patients diagnosed with stroke (OR: 1.26, 95% CI: 1.05–1.52), cardiac arrest (OR: 1.85, 95% CI: 1.65–2.07) or intracerebral haemorrhage (OR: 1.48, 95% CI: 1.19–1.84), omission of VTE prophylaxis was associated with increased risk of mortality, but not in patients diagnosed with subarachnoid haemorrhage or head injury.ConclusionsOmission of VTE prophylaxis within the first 24 h after ICU admission was independently associated with increased risk of mortality that varied by admission diagnosis. Consideration of early thromboprophylaxis may be required for patients with stroke, cardiac arrest and intracerebral haemorrhage but not in those with subarachnoid haemorrhage or head injury. The findings highlight the importance of individualised diagnosis-related thromboprophylaxis benefit-harm assessments.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1