Thromboprophylaxis in Intensive Care Unit Patients: A Literature Review

Ejaz, Amna; Ahmed, Munis M; Tasleem, Azka; Niazi, Muhammad; Ahsraf, Muhammad Farhan; Ahmad, Imama; Zakir, Asma; Raza, Awais

doi:10.7759/cureus.3341

Cited by 34 publications

(39 citation statements)

References 42 publications

(46 reference statements)

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“…Thrombosis is a well‐recognized cause of morbidity and mortality in people, with large studies documenting reduced risk of thrombotic complications with institution of anticoagulant therapy . Despite growing awareness of thrombosis as a manifestation of disease in veterinary medicine, few large studies quantifying risk are available to inform decisions related to anticoagulation leading to inconsistent and anecdotal application of antithrombotic therapy.…”

Section: Introductionmentioning

confidence: 99%

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1—Defining populations at risk

deLaforcade

Bacek

Blais

et al. 2019

J Vet Emergen Crit Care

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Objectives:Thrombosis is a well-recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current veterinary literature, to provide the basis for prescribing recommendations.Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines.Diseases evaluated included immune-mediated hemolytic anemia, protein-losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease.Settings: Academic and referral veterinary medical centers.

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Section: Introductionmentioning

confidence: 99%

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1—Defining populations at risk

deLaforcade

Bacek

Blais

et al. 2019

J Vet Emergen Crit Care

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“…The risk of heparin in this patient is bleeding, because heparin can worsen the state of thrombocytopenia. 19 The patient also performed an abdominal ultrasound examination and showed an enlargement of the pancreas. This can occur due to suppression due to enlargement of the paraaortic lymph nodes against the pancreas by lymphoma malignum.…”

Section: Case Reportmentioning

confidence: 99%

Diffuse large B-cell lymphoma in a patient with chronic myelogenous leukemia on accelerated phase with bilateral pleural effusion: a case report

Zukhrufan¹,

Faheri²

2020

Int J Res Med Sci

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Chronic Myelogenous Leukemia (CML) is a myeloproliferative disorder of pluripotent stem cells. The pathogenesis of CML is known to be related to mutations in the form of Philadelphia chromosomes. The incidence of CML constitutes 20% of all cases of leukemia in adults. The current gold standard for CML therapy is using tyrosine kinase inhibitors (TKI), Imatinib. Non-Hodgkin Lymphoma (NHL) is a malignancy that develops from lymph nodes. In NHL the formation of malignant cells is in the form of lymphocytes that are at one of the differentiation levels of either T lymphocytes or B lymphocytes. Diffuse large B cell lymphoma is the most common NHL, representing about 40% of all lymphoma cases. NHL management is targeted chemotherapy using rituximab combined with cyclophosphamide, doxorubicine, vincristine and prednisone. A Thirty-four year-old female patient has been reported with the main complaint of fatigue and pale weakness accompanied by an enlarged abdomen. Complaints are also accompanied by a lump in the right neck, fever, productive cough and shortness of breath. The patient has been known to suffer from CML with BCR-ABL (+) since five years ago and received Imatinib therapy, but then the patient stopped treatment himself. On physical examination found anemic, multiple enlargement of the neck lymph nodes, wet crackles soft and loud in the basal of both lungs and splenomegaly. On investigations found severe anemia, thrombocytopenia and blast 13%, increased d-dimer, bronchopneumonia-compliant infiltrate and bilateral pleural effusion on chest x-ray, results of exudate pleural fluid analysis with the cytology of a malignant smear metastasis of lymphoma to the pleura, histopathology of the neck lymph nodes with chest x-ray, analysis of exudate pleural fluid with the cytology of a malignant smear metastasis of lymphoma into the pleura, histopathology of the neck lymph nodes with the results of diffuse large B-Cell lymphoma, as well as enlargement of paraaortic lymph nodes, hepatosplenomegaly and chronic pancreatitis on abdominal ultrasound. Patients was given antibiotics, transfusion of packed red cells and platelets, pleural tap and chemotherapy. The patient was planned to undergo chemotherapy for 6 cycles of 21 days, and a CD20 examination was performed. The incidence of NHL in patients with good CML in imatinib therapy is not yet certain whether there is a direct relationship.

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“…ICU patients have a higher risk for thromboembolic events due to immobilization and invasive procedures (intubation, central arterial and venous lines) [1,2]. Pulmonary embolism is a leading cause of death in critically ill patients [3].…”

Section: Introductionmentioning

confidence: 99%

Thromboprophylaxis, Delta SOFA and Main Outcomes in Ventilated Patients: An Analysis of the MIMIC-III Clinical Database

Bastola¹,

Locatis²,

Fontelo³

2020

Preprint

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Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners. Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT). Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia episodes, which required platelets transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)). Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). The results of this analysis might help practitioners select, maintain, and switch blood thinners in ventilated patients.

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Thromboprophylaxis in Intensive Care Unit Patients: A Literature Review

Cited by 34 publications

References 42 publications

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1—Defining populations at risk

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1—Defining populations at risk

Diffuse large B-cell lymphoma in a patient with chronic myelogenous leukemia on accelerated phase with bilateral pleural effusion: a case report

Thromboprophylaxis, Delta SOFA and Main Outcomes in Ventilated Patients: An Analysis of the MIMIC-III Clinical Database

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