血液恶性肿瘤重症患者的静脉血栓栓塞性疾病发病率和出血风险：回顾性研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2024-11-01 DOI:10.1016/j.medin.2024.05.014

Federico C. Carini , Laveena Munshi , Igor Novitzky-Basso , Graham Dozois , Camila Heredia , Sotirios Damouras , Bruno L. Ferreyro , Sangeeta Mehta

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引用次数: 0

摘要

目标我们的目标是描述血液恶性肿瘤（HM）重症患者血栓预防措施的使用情况和 VTE/出血的发生率。主要关注变量我们分析了人口统计学数据、血栓预防措施的使用情况以及次要结果，包括 VTE（静脉血栓栓塞症）发生率、出血、死亡率、严重程度评分和器官支持。我们采用多变量逻辑回归模型来研究重症监护病房血栓形成的风险。65%的入院患者接受了血栓预防治疗（LMWH 14%、UFH 8%、SCDs 43%）；21%的患者因血小板减少而禁用；14%的病例缺乏预防记录。VTE病例共有38例（深静脉血栓27例、聚乙烯醇11例），占重症监护病房病例的4.4%。大多数 VTE 病例发生在不同程度血小板减少的患者身上。在多变量分析中，ICU 第一天的 SOFA 评分与 VTE 风险独立相关（OR 0.85，95% CI 0.76-0.96）。出血发生率为7.2%（轻微）和14.4%（严重）；最常见的部位是中枢神经系统、腹部/消化道和肺部。VTE发生率为4.4%，大出血发生率为14%。血液恶性肿瘤和造血细胞移植患者的静脉血栓栓塞症：一项回顾性研究》(https://clinicaltrials.gov/)。

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Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study

Objective

Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).

Design

Retrospective cohort study (2014–2022).

Setting

Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.

Patients

Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.

Interventions

None.

Main variables of interest

We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU.

Results

We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary.

Conclusions

In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%.

Clinical Trial Registration

NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).