Thrombocytopenia in critically ill patients receiving thromboprophylaxis : frequency, risk factors, and outcomes
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.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2013 |
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| Erschienen: |
2013 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:144 |
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| Enthalten in: |
Chest - 144(2013), 4 vom: 29. Okt., Seite 1207-1215 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Williamson, David R [VerfasserIn] |
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| Links: |
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| Themen: |
9005-49-6 |
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| Anmerkungen: |
Date Completed 06.01.2014 Date Revised 31.03.2022 published: Print ClinicalTrials.gov: NCT00182143 CommentIn: Chest. 2013 Dec;144(6):1979. - PMID 24297147 Citation Status MEDLINE |
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| doi: |
10.1378/chest.13-0121 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM228529883 |
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| 100 | 1 | |a Williamson, David R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Thrombocytopenia in critically ill patients receiving thromboprophylaxis |b frequency, risk factors, and outcomes |
| 264 | 1 | |c 2013 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 06.01.2014 | ||
| 500 | |a Date Revised 31.03.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT00182143 | ||
| 500 | |a CommentIn: Chest. 2013 Dec;144(6):1979. - PMID 24297147 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Heparin, Low-Molecular-Weight |2 NLM | |
| 650 | 7 | |a Heparin |2 NLM | |
| 650 | 7 | |a 9005-49-6 |2 NLM | |
| 700 | 1 | |a Albert, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Heels-Ansdell, Diane |e verfasserin |4 aut | |
| 700 | 1 | |a Arnold, Donald M |e verfasserin |4 aut | |
| 700 | 1 | |a Lauzier, François |e verfasserin |4 aut | |
| 700 | 1 | |a Zarychanski, Ryan |e verfasserin |4 aut | |
| 700 | 1 | |a Crowther, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Warkentin, Theodore E |e verfasserin |4 aut | |
| 700 | 1 | |a Dodek, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Cade, John |e verfasserin |4 aut | |
| 700 | 1 | |a Lesur, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Wendy |e verfasserin |4 aut | |
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| 700 | 1 | |a Lamontagne, Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Langevin, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Freitag, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Muscedere, John |e verfasserin |4 aut | |
| 700 | 1 | |a Friedrich, Jan O |e verfasserin |4 aut | |
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| 700 | 0 | |a PROTECT collaborators, the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group |e verfasserin |4 aut | |
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