Sex differences in thromboprophylaxis of the critically ill : a secondary analysis of a randomized trial
© 2023. Canadian Anesthesiologists' Society..
PURPOSE: Venous thromboembolism (VTE) is a common complication of critical illness. Sex- or gender-based analyses are rarely conducted and their effect on outcomes is unknown. We assessed for an effect modification of thromboprophylaxis (dalteparin or unfractionated heparin [UFH]) by sex on thrombotic (deep venous thrombosis [DVT], pulmonary embolism [PE], VTE) and mortality outcomes in a secondary analysis of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT).
METHODS: We conducted unadjusted analyses using Cox proportional hazards analysis, stratified by centre and admission diagnostic category, including sex, treatment, and an interaction term. Additionally, we performed adjusted analyses and assessed the credibility of our findings.
RESULTS: Critically ill female (n = 1,614) and male (n = 2,113) participants experienced similar rates of DVT, proximal DVT, PE, any VTE, ICU death, and hospital death. In unadjusted analyses, we did not find significant differences in treatment effect favouring males (vs females) treated with dalteparin (vs UFH) for proximal leg DVT, any DVT, or any PE, but found a statistically significant effect (moderate certainty) favouring dalteparin in males for any VTE (males: hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96 vs females: HR, 1.16; 95% CI, 0.81 to 1.68; P = 0.04). This effect remained after adjustment for baseline characteristics (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.17; 95% CI, 0.81 to 1.68; P = 0.04) and weight (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.20; 95% CI, 0.83 to 1.73; P = 0.03). We did not identify a significant effect modification by sex on mortality.
CONCLUSIONS: We found an effect modification by sex of thromboprophylaxis on VTE in critically ill patients that requires confirmation. Our findings highlight the need for sex- and gender-based analyses in acute care research.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:70 |
|---|---|
| Enthalten in: |
Canadian journal of anaesthesia = Journal canadien d'anesthesie - 70(2023), 6 vom: 21. Juni, Seite 1008-1018 |
| Sprache: |
Englisch |
|---|
| Weiterer Titel: |
Différences entre les sexes en matière de thomboprophylaxie chez les patients en état critique : analyse secondaire d’un essai randomisé |
|---|
| Beteiligte Personen: |
Burns, Karen E A [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
9005-49-6 |
|---|
| Anmerkungen: |
Date Completed 13.07.2023 Date Revised 26.12.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s12630-023-02457-8 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM358122856 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM358122856 | ||
| 003 | DE-627 | ||
| 005 | 20231229123840.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s12630-023-02457-8 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1240.xml |
| 035 | |a (DE-627)NLM358122856 | ||
| 035 | |a (NLM)37310606 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Burns, Karen E A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Sex differences in thromboprophylaxis of the critically ill |b a secondary analysis of a randomized trial |
| 246 | 3 | 3 | |a Différences entre les sexes en matière de thomboprophylaxie chez les patients en état critique : analyse secondaire d’un essai randomisé |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 13.07.2023 | ||
| 500 | |a Date Revised 26.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. Canadian Anesthesiologists' Society. | ||
| 520 | |a PURPOSE: Venous thromboembolism (VTE) is a common complication of critical illness. Sex- or gender-based analyses are rarely conducted and their effect on outcomes is unknown. We assessed for an effect modification of thromboprophylaxis (dalteparin or unfractionated heparin [UFH]) by sex on thrombotic (deep venous thrombosis [DVT], pulmonary embolism [PE], VTE) and mortality outcomes in a secondary analysis of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT) | ||
| 520 | |a METHODS: We conducted unadjusted analyses using Cox proportional hazards analysis, stratified by centre and admission diagnostic category, including sex, treatment, and an interaction term. Additionally, we performed adjusted analyses and assessed the credibility of our findings | ||
| 520 | |a RESULTS: Critically ill female (n = 1,614) and male (n = 2,113) participants experienced similar rates of DVT, proximal DVT, PE, any VTE, ICU death, and hospital death. In unadjusted analyses, we did not find significant differences in treatment effect favouring males (vs females) treated with dalteparin (vs UFH) for proximal leg DVT, any DVT, or any PE, but found a statistically significant effect (moderate certainty) favouring dalteparin in males for any VTE (males: hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96 vs females: HR, 1.16; 95% CI, 0.81 to 1.68; P = 0.04). This effect remained after adjustment for baseline characteristics (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.17; 95% CI, 0.81 to 1.68; P = 0.04) and weight (males: HR, 0.70; 95% CI, 0.52 to 0.96 vs females: HR, 1.20; 95% CI, 0.83 to 1.73; P = 0.03). We did not identify a significant effect modification by sex on mortality | ||
| 520 | |a CONCLUSIONS: We found an effect modification by sex of thromboprophylaxis on VTE in critically ill patients that requires confirmation. Our findings highlight the need for sex- and gender-based analyses in acute care research | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a deep venous thrombosis | |
| 650 | 4 | |a prophylaxis | |
| 650 | 4 | |a pulmonary embolism | |
| 650 | 4 | |a sex differences | |
| 650 | 4 | |a venous thromboembolism | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Heparin |2 NLM | |
| 650 | 7 | |a 9005-49-6 |2 NLM | |
| 650 | 7 | |a Dalteparin |2 NLM | |
| 650 | 7 | |a S79O08V79F |2 NLM | |
| 700 | 1 | |a Heels-Ansdell, Diane |e verfasserin |4 aut | |
| 700 | 1 | |a Thabane, Lehana |e verfasserin |4 aut | |
| 700 | 1 | |a Kahn, Susan R |e verfasserin |4 aut | |
| 700 | 1 | |a Lauzier, Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Mehta, Sangeeta |e verfasserin |4 aut | |
| 700 | 1 | |a Ostermann, Marlies |e verfasserin |4 aut | |
| 700 | 1 | |a Bhuptani, Pulkit |e verfasserin |4 aut | |
| 700 | 1 | |a Crowther, Mark A |e verfasserin |4 aut | |
| 700 | 1 | |a Finfer, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Cook, Deborah J |e verfasserin |4 aut | |
| 700 | 0 | |a PROTECT Investigators, the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Canadian journal of anaesthesia = Journal canadien d'anesthesie |d 1987 |g 70(2023), 6 vom: 21. Juni, Seite 1008-1018 |w (DE-627)NLM012607282 |x 1496-8975 |7 nnns |
| 773 | 1 | 8 | |g volume:70 |g year:2023 |g number:6 |g day:21 |g month:06 |g pages:1008-1018 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s12630-023-02457-8 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 70 |j 2023 |e 6 |b 21 |c 06 |h 1008-1018 | ||