Najib T Ayas1, Peter M Dodek, Hong Wang, Robert Fowler, Hubert Wong, Monica Norena. 1. From the *Division of Critical Care Medicine and Department of Medicine, Providence Health Care and University of British Columbia; †Center for Health Evaluation and Outcome Sciences, Providence Health Care; ‡Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia; §Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; ∥School of Population and Public Health, University of British Columbia; and ¶CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.
Abstract
OBJECTIVE: The aim of this study was to determine the attributable length of stay and mortality due to bleeding as a complication of therapeutic anticoagulation in intensive care unit (ICU) patients. METHODS: Charts of patients from 7 ICUs in British Columbia were screened daily for the occurrence of major bleeding while receiving therapeutic heparin. To determine attributable length of stay and mortality, a matched and unmatched cohort design as well as multivariate analysis were used. We included only patients who were started on anticoagulation on or after day 2 in the ICU. RESULTS: Between 2006 and 2009, a total of 868 patients were started on therapeutic anticoagulation and 139 bled. One hundred five patients who bled were matched to 261 controls. In the matched analysis after adjustment for potential confounders, each bleeding event was associated with an increase in ICU length of stay (hazard ratio for ICU discharge, 0.47; 95% confidence interval, 0.38-0.57; attributable ICU length of stay of 13.8 days). Hospital length of stay was also significantly increased. In the entire cohort analysis, bleeding was also associated with increased ICU length of stay (hazard ratio, 0.59; confidence interval, 0.48-0.72; attributable stay of 6.1 days) and increased hospital length of stay. In both analyses, bleeding was not associated with hospital mortality. CONCLUSIONS: Major bleeding while receiving anticoagulation is associated with a substantial increase in ICU and hospital length of stay.
OBJECTIVE: The aim of this study was to determine the attributable length of stay and mortality due to bleeding as a complication of therapeutic anticoagulation in intensive care unit (ICU) patients. METHODS: Charts of patients from 7 ICUs in British Columbia were screened daily for the occurrence of major bleeding while receiving therapeutic heparin. To determine attributable length of stay and mortality, a matched and unmatched cohort design as well as multivariate analysis were used. We included only patients who were started on anticoagulation on or after day 2 in the ICU. RESULTS: Between 2006 and 2009, a total of 868 patients were started on therapeutic anticoagulation and 139 bled. One hundred five patients who bled were matched to 261 controls. In the matched analysis after adjustment for potential confounders, each bleeding event was associated with an increase in ICU length of stay (hazard ratio for ICU discharge, 0.47; 95% confidence interval, 0.38-0.57; attributable ICU length of stay of 13.8 days). Hospital length of stay was also significantly increased. In the entire cohort analysis, bleeding was also associated with increased ICU length of stay (hazard ratio, 0.59; confidence interval, 0.48-0.72; attributable stay of 6.1 days) and increased hospital length of stay. In both analyses, bleeding was not associated with hospital mortality. CONCLUSIONS: Major bleeding while receiving anticoagulation is associated with a substantial increase in ICU and hospital length of stay.