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).
METHODS: Retrospective cohort study (2014-2022).
METHODS: Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.
METHODS: Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.
METHODS: None.
METHODS: 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%.
BACKGROUND: NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).
METHODS: Retrospective cohort study (2014-2022).
METHODS: Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.
METHODS: Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.
METHODS: None.
METHODS: 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%.
BACKGROUND: NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).
摘要：
目的：我们的目的是描述血液系统恶性肿瘤（HM）危重患者的血栓预防和VTE/出血的发生率。
方法：回顾性队列研究（2014-2022）。
方法：三级护理学术中心的内科外科重症监护病房（ICU）。
方法：入住ICU的成年患者同时诊断为血液系统恶性肿瘤。
方法：无。
方法：我们分析了人口统计数据，使用血栓预防和次要结局，包括VTE（静脉血栓栓塞）的发生率，出血,死亡率,严重程度评分和器官支持。我们应用多变量逻辑回归模型来检查ICU血栓形成的风险。
结果：我们纳入了862名ICU患者（813名独特患者）。在65%的入院期间给予血栓预防(LMWH14%，UFH8%,和SCDs43％）；由于血小板减少症，有21％的患者禁忌；14％的病例缺乏预防文件。有38例独特的VTE事件（27例DVT，11PE),占ICU发作的4.4%。大多数VTE病例发生在不同程度的血小板减少患者中。在多变量分析中，ICU第一天的SOFA评分与VTE的风险独立相关（OR0.85，95％CI0.76-0.96）。出血发生在7.2%(轻微)和14.4%(主要)的发作;最常见的部位是中枢神经系统,腹部/胃肠道和肺部。
结论：在此队列中，DVT预防的使用存在相当大的差异，主要使用SCD。VTE发生率为4.4%，大出血发生率为14%。
背景：NCT05396157。血液系统恶性肿瘤和造血细胞移植患者的静脉血栓栓塞：一项回顾性研究（https://clinicaltrials.gov/）。
方法：回顾性队列研究（2014-2022）。
方法：三级护理学术中心的内科外科重症监护病房（ICU）。
方法：入住ICU的成年患者同时诊断为血液系统恶性肿瘤。
方法：无。
方法：我们分析了人口统计数据，使用血栓预防和次要结局，包括VTE（静脉血栓栓塞）的发生率，出血,死亡率,严重程度评分和器官支持。我们应用多变量逻辑回归模型来检查ICU血栓形成的风险。
结果：我们纳入了862名ICU患者（813名独特患者）。在65%的入院期间给予血栓预防(LMWH14%，UFH8%,和SCDs43％）；由于血小板减少症，有21％的患者禁忌；14％的病例缺乏预防文件。有38例独特的VTE事件（27例DVT，11PE),占ICU发作的4.4%。大多数VTE病例发生在不同程度的血小板减少患者中。在多变量分析中，ICU第一天的SOFA评分与VTE的风险独立相关（OR0.85，95％CI0.76-0.96）。出血发生在7.2%(轻微)和14.4%(主要)的发作;最常见的部位是中枢神经系统,腹部/胃肠道和肺部。
结论：在此队列中，DVT预防的使用存在相当大的差异，主要使用SCD。VTE发生率为4.4%，大出血发生率为14%。
背景：NCT05396157。血液系统恶性肿瘤和造血细胞移植患者的静脉血栓栓塞：一项回顾性研究（https://clinicaltrials.gov/）。
