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IF 2.6 4区医学 Q2 HEMATOLOGY

Thrombosis Journal Pub Date : 2025-03-10 DOI:10.1186/s12959-025-00703-1

Abdulmajeed M Alshehri, Mohammed Alrashed, Mohammed Alzahrani, Abdulmajeed Alsuwaylihi, Abdulaziz Alarifi, Faris Althobiti, Majed S Al Yami

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引用次数: 0

摘要

背景：直接口服抗凝血剂（DOACs）作为一线药物广泛应用于各种临床环境。然而，鉴于有关其在重症监护室（ICU）重症患者中安全性的文献空白，以及出血和药代动力学改变的担忧，有关其在重症监护室重症患者中使用的证据非常少。因此，本研究旨在评估重症患者使用 DOAC 的处方模式和安全性：这是一项单中心回顾性病历研究，研究对象是院前已确认使用 DOACs 的重症患者，他们在入住内科 ICU 和/或冠心病监护病房（CCU）期间要么继续使用 DOACs，要么改用治疗性肠道外抗凝剂（依诺肝素或肝素）。主要结果是大出血（MB）事件的发生率。次要结果包括新血栓形成发生率、内科 ICU/CCU 死亡率、住院时间和内科 ICU/CCU 住院时间：共筛选出 675 名患者纳入研究。共有 302 名患者被纳入最终分析，其中 DOAC 组有 167 名患者，肠外抗凝剂组有 135 名患者。两组患者的 MB 发生率（11% 对 9%，P = 0.61）或新血栓形成率（1% 对 3%，P = 0.50）没有差异。与肠外抗凝剂组相比，DOAC 组的内科 ICU/CCU 总死亡率较低（7% 对 15%，P = 0.03）。此外，DOAC 组在内科 ICU/CCU 的住院时间更短（6 天 [4-11] 对 11 天 [5-24]，p 结论：DOAC 组的住院时间更短，但死亡率更高：与使用肠外抗凝剂相比，重症患者使用 DOAC 与 MB 和新血栓事件的发生率相似。观察到的组间死亡率和住院时间差异可能是由于医生在制定抗凝策略时存在差异，这可能受到患者特异性因素和病情严重程度的影响。有必要进一步开展前瞻性研究，以确定重症患者的最佳抗凝策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Evaluation of direct oral anticoagulant continuation versus switching to a parenteral anticoagulant in critically ill patients: a retrospective cohort study.

Background: Direct oral anticoagulants (DOACs) are widely used as first-line agents in various clinical settings. However, there is very little evidence regarding their use in critically ill patients in the intensive care unit (ICU), given the gap in the literature regarding their safety in this population and the concerns of bleeding and alterations in pharmacokinetics. Therefore, this study aimed to evaluate the prescribing pattern and safety of DOAC use in critically ill patients.

Methods: This was a single-centre retrospective chart review study involving critically ill patients with confirmed prehospital use of DOACs who either continued their use of DOACs or switched to a therapeutic parenteral anticoagulant agent (enoxaparin or heparin) during the admission to the medical ICU and/or coronary care unit (CCU). The primary outcome was the incidence of major bleeding (MB) events. The secondary outcomes included the incidence of new thrombosis and medical ICU/CCU mortality and hospital and medical ICU/CCU lengths of stay (LOS).

Results: A total of 675 patients were screened for inclusion. A total of 302 patients were included in the final analysis, with 167 patients in the DOAC group and 135 patients in the parenteral anticoagulant group. There were no differences between the groups in terms of the incidence of MB (11% vs. 9%, p = 0.61) or new thrombosis (1% vs. 3%, p = 0.50). The overall medical ICU/CCU mortality rate was lower in the DOAC group compared to the parenteral anticoagulant group (7% vs. 15%, p = 0.03). Additionally, the DOAC group had shorter medical ICU/CCU stays (6 days [4-11] vs. 11 days [5-24], p < 0.001) and shorter hospital stays (7 days [5-13] vs. 13 days [7-35], p < 0.001), respectively.

Conclusion: Compared with the use of parenteral anticoagulants, the use of DOACs in critically ill patients was associated with a similar incidence of MB and new thrombotic events. The observed differences in mortality and LOS between the groups may be attributed to variability in physician decision-making regarding anticoagulation strategies, potentially influenced by patient-specific factors and severity of illness. Further prospective studies to determine the optimal anticoagulation strategy in critically ill patients are warranted.

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来源期刊

Thrombosis Journal Medicine-Hematology

CiteScore

3.80

自引率

3.20%

发文量

审稿时长

16 weeks

期刊介绍： Thrombosis Journal is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis. Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.