David R Williamson1, Martin Albert2, Diane Heels-Ansdell3, Donald M Arnold4, François Lauzier5, Ryan Zarychanski6, Mark Crowther3, Theodore E Warkentin7, Peter Dodek8, John Cade9, Olivier Lesur10, Wendy Lim11, Robert Fowler12, Francois Lamontagne10, Stephan Langevin5, Andreas Freitag11, John Muscedere13, Jan O Friedrich14, William Geerts12, Lisa Burry15, Jamal Alhashemi16, Deborah Cook17. 1. Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada; Department of Pharmacy, Université de Montréal, Montreal, QC, Canada. Electronic address: david.williamson@umontreal.ca. 2. Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada; Department of Medicine, Université de Montréal, Montreal, QC, Canada. 3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 4. Canadian Blood Services, Ottawa, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 5. Centre de recherche du CHU de Québec and Université Laval, Montreal, QC, Canada. 6. Cancercare Manitoba and University of Manitoba, Winnipeg, MB, Canada. 7. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. 8. St.Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 9. Royal Melbourne Hospital, Melbourne, VIC, Australia. 10. Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada. 11. Department of Medicine, McMaster University, Hamilton, ON, Canada. 12. Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Center, Toronto, ON, Canada. 13. Kingston General Hospital and Queens University, Kingston, ON, Canada. 14. Department of Medicine, University of Toronto, Toronto, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada. 15. Mount Sinai Hospital, Toronto, ON, Canada. 16. King Abdulaziz University, Jeddah, Saudi Arabia. 17. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND:Thrombocytopenia is the most common hemostatic disorder in critically ill patients. The objective of this study was to describe the incidence, risk factors, and outcomes of thrombocytopenia in patients admitted to medical-surgical ICUs. METHODS:Three thousand seven hundred forty-six patients in 67 centers were enrolled in a randomized trial in which unfractionated heparin was compared with low-molecular-weight heparin (LMWH) for thromboprophylaxis. Patients who had baseline platelet counts < 75 × 10(9)/L or severe coagulopathy at screening were excluded. We analyzed the risk of developing mild (100-149 × 10(9)/L), moderate (50-99 × 10(9)/L), and severe (< 50 × 109/L) thrombocytopenia during an ICU stay. We also assessed independent and time-varying predictors of thrombocytopenia and the effect of thrombocytopenia on major bleeding, transfusions, and death. RESULTS: The incidences of mild, moderate, and severe thrombocytopenia were 15.3%, 5.1%, and 1.6%, respectively. The predictors of each category of thrombocytopenia were APACHE (Acute Physiology and Chronic Health Evaluation) II score, use of inotropes or vasopressors, and renal replacement therapy. The risk of moderate thrombocytopenia was lower in patients who received LMWH thromboprophylaxis but higher in surgical patients and in patients who had liver disease. Each category of thrombocytopenia was associated with subsequent bleeding and transfusions. Moderate and severe thrombocytopenia were associated with increased ICU and hospital mortality. CONCLUSION: A high severity of illness, prior surgery, use of inotropes or vasopressors, renal replacement therapy, and liver dysfunction are associated with a higher risk of thrombocytopenia developing in the ICU, whereas LMWH thromboprophylaxis is associated with a lower risk. Patients who develop thrombocytopenia in the ICU are more likely to bleed, receive transfusions, and die.
RCT Entities:
BACKGROUND:Thrombocytopenia is the most common hemostatic disorder in critically illpatients. The objective of this study was to describe the incidence, risk factors, and outcomes of thrombocytopenia in patients admitted to medical-surgical ICUs. METHODS: Three thousand seven hundred forty-six patients in 67 centers were enrolled in a randomized trial in which unfractionated heparin was compared with low-molecular-weight heparin (LMWH) for thromboprophylaxis. Patients who had baseline platelet counts < 75 × 10(9)/L or severe coagulopathy at screening were excluded. We analyzed the risk of developing mild (100-149 × 10(9)/L), moderate (50-99 × 10(9)/L), and severe (< 50 × 109/L) thrombocytopenia during an ICU stay. We also assessed independent and time-varying predictors of thrombocytopenia and the effect of thrombocytopenia on major bleeding, transfusions, and death. RESULTS: The incidences of mild, moderate, and severe thrombocytopenia were 15.3%, 5.1%, and 1.6%, respectively. The predictors of each category of thrombocytopenia were APACHE (Acute Physiology and Chronic Health Evaluation) II score, use of inotropes or vasopressors, and renal replacement therapy. The risk of moderate thrombocytopenia was lower in patients who received LMWH thromboprophylaxis but higher in surgical patients and in patients who had liver disease. Each category of thrombocytopenia was associated with subsequent bleeding and transfusions. Moderate and severe thrombocytopenia were associated with increased ICU and hospital mortality. CONCLUSION: A high severity of illness, prior surgery, use of inotropes or vasopressors, renal replacement therapy, and liver dysfunction are associated with a higher risk of thrombocytopenia developing in the ICU, whereas LMWH thromboprophylaxis is associated with a lower risk. Patients who develop thrombocytopenia in the ICU are more likely to bleed, receive transfusions, and die.
Authors: Benjamin R Griffin; Anna Jovanovich; Zhiying You; Paul Palevsky; Sarah Faubel; Diana Jalal Journal: Crit Care Med Date: 2019-04 Impact factor: 7.598
Authors: Miklos D Kertai; Shan Zhou; Jörn A Karhausen; Mary Cooter; Edmund Jooste; Yi-Ju Li; William D White; Solomon Aronson; Mihai V Podgoreanu; Jeffrey Gaca; Ian J Welsby; Jerrold H Levy; Mark Stafford-Smith; Joseph P Mathew; Manuel L Fontes Journal: Anesthesiology Date: 2016-02 Impact factor: 7.892