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Vol. 48. Issue 11.
Pages e1-e9 (November 2024)
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Vol. 48. Issue 11.
Pages e1-e9 (November 2024)
Original article
Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study
Incidencia de enfermedad tromboembólica venosa y riesgo de hemorragia en pacientes críticos con neoplasias hematológicas: un estudio retrospectivo
Federico C. Carinia,
Corresponding author
, Laveena Munshia, Igor Novitzky-Bassob, Graham Dozoisb, Camila Herediac, Sotirios Damourasd, Bruno L. Ferreyroa, Sangeeta Mehtaa
a Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
b Princess Margaret Cancer Centre, Department of Medical Oncology; University Health Network, Toronto, Ontario, Canada
c Faculty of Health, York University, Toronto, Ontario, Canada
d Department of Computer & Mathematical Sciences, University of Toronto Scarborough, Ontario, Canada
Article information
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Figures (1)
Tables (4)
Table 1. Patient characteristics at baseline and according to thromboprophylaxis disease.
Table 2. DVT prophylaxis according to platelets count.
Table 3. Thrombosis and Bleeding by VTE Prophylaxis.
Table 4. Thrombosis and Bleeding by Platelet counts.
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Additional material (1)
Abstract
Objective

Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).

Design

Retrospective cohort study (2014–2022).

Setting

Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.

Patients

Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.

Interventions

None.

Main variables of interest

We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU.

Results

We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary.

Conclusions

In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%.

Clinical Trial Registration

NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

Keywords:
Hematologic malignancy
Intensive care unit
DVT
Pulmonary embolism
VTE
Thrombosis
Abbreviation list:
CPG
DVT
EHR
HCT
HM
ICU
LMWH
PE
SCD
UFH
VTE
Resumen
Objetivo

Describir el uso de tromboprofilaxis y la incidencia de enfermedad tromboembólica y/o sangrado en pacientes críticos con enfermedad oncohematológica.

Diseño

Estudio retrospectivo de cohorte (2014–2022).

Ámbito

Unidad cuidados intensivos medico-quirúrgica de un hospital terciario académico en Toronto, Canadá.

Pacientes

Adultos con diagnóstico de enfermedad oncohematológica ingresados ​​en la UCI.

Intervenciones

Ninguna.

Variables de interés principales

Se analizaron los datos demográficos, el tipo de tromboprofilaxis utilizada y el riesgo de sangrado junto con los factores relacionados con éstos. Se aplicó un análisis de regresión logística multivariante para evaluar factores de riesgo para trombosis en la UCI.

Resultados

Se incluyeron 862 episodios de ingreso en la UCI (813 pacientes únicos). Se utilizó tromboprofilaxis en el 65% de los casos (heparina de bajo peso molecular 14%, heparina no fraccionada 8% y medios mecánicos 43%); en el 21% estuvo contraindicado por trombocitopenia y en el 14% de los casos no había documentación sobre profilaxis. Hubo 38 casos incidentes de enfermedad trombo embólica venosa o ETEV (27 trombosis venosa profunda, 11 embolismo pulmonar), lo que constituye el 4,4% de los episodios en la UCI. La mayoría de los casos de ETEV ocurrieron en pacientes con diversos grados de trombocitopenia. La puntuación SOFA en el primer día de UCI se relacionó de forma independiente en el análisis multivariable (OR 0.85, 95% CI 0.76−0.96) con el riesgo de ETEV. Se registró sangrado en el 7,2% (menor) y en el 14,4% (mayor) de los episodios; los sitios más frecuentes fueron el SNC, abdomen/GI y pulmonar.

Conclusiones

En esta cohorte de pacientes críticos con enfermedad oncohematológica, hubo una variabilidad considerable en la utilización de la profilaxis de la TVP, con un uso predominante de métodos mecánicos. La incidencia de ETEV fue del 4,4% y la de hemorragia mayor del 14%.

Palabras clave:
Enfermedad oncohematológica
Unidad de cuidados intensivos
Enfermedad tromboembólica venosa
Tromboembolismo de pulmón
Trombosis

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