Thrombosis and Hemostasis Issues in Critically Ill Patients

Levi, Marcel

doi:10.1055/s-0035-1544216

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Critically ill patients often present with thrombocytopenia. 3 The incidence of thrombocytopenia (platelet count < 150 Â 10 9 /L) in critically ill medical patients is 35 to 40%. [4][5][6] A platelet count of < 100 Â 10 9 /L is seen in 20 to 25% of patients, whereas 10 to 15% of patients have a platelet count < 50 Â 10 9 /L.…”

Section: Thrombocytopenia In Critically Ill Patientsmentioning

confidence: 99%

“…Regardless of the cause, thrombocytopenia is an independent predictor of ICU mortality in multivariate analyses with a relative risk of 1.9 to 4.2 in various studies. 3,4,7 Several studies show that the number of platelets in critically ill patients is inversely related to survival. In particular, sustained thrombocytopenia over more than 4 days after ICU admission or a drop in platelet count of > 50% during ICU stay is related to a four-to sixfold increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

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Platelets in Critical Illness

Levi

2016

Semin Thromb Hemost

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In patients with critical illness, thrombocytopenia is a frequent laboratory abnormality. However frequent this may occur, a low platelet count is not an epiphenomenon, but a marker with further significance. It is always important to assess the proper cause for thrombocytopenia in critically ill patients because different underlying disorders may precipitate different diagnostic and therapeutic management strategies. Platelets are part of the first-line defense of the body against bleeding; hence, thrombocytopenia may increase the risk of hemorrhage. In case of systemic inflammatory syndromes, such as the response to sepsis, disseminated intravascular platelet activation may occur. This will contribute to microvascular failure and thereby play a role in the development of organ dysfunction. Platelets are circulating blood cells that will normally not interact with the intact vessel wall but that may swiftly respond to endothelial disruption (which is often part of the pathogenesis of critical illness) by adhering to subendothelial structures, followed by interaction with each other, thereby forming a platelet aggregate. The activated platelet (phospholipid) membrane may form a suitable surface on which further coagulation activation may occur. A low platelet count is a strong and independent predictor of an adverse outcome in critically ill patients, thereby facilitating a simple and practically risk assessment in these patients and potentially guiding the use of complex or expensive treatment strategies.

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Section: Thrombocytopenia In Critically Ill Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelets in Critical Illness

Levi

2016

Semin Thromb Hemost

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“…6 Furthermore, based on a large meta-analysis done by Ho and Tan in 2013, it was found that for hospitalized patients, in general, IPC was effective in reducing VTE, and combining pharmacological thromboprophylaxis with IPC was more effective than using IPC alone, this conclusion does not apply to critically ill patients, especially with conflicting data in the literature. 7,8 With the emergence of large randomized controlled trials (RCTs), 9 we aim to evaluate the efficacy of IPC compared with other thromboprophylaxis measures and their combinations in critically ill hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of the Role of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients

Haykal

Zayed

Dhillon

et al. 2020

The International Journal of Lower Extremity Wounds

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Critically ill patients (patients treated in a medical or surgical intensive care unit) are at high risk of venous thromboembolism (VTE) development (deep vein thrombosis [DVT] and/or pulmonary embolism). Multiple thromboprophylaxis strategies have been used for the prevention of VTE in this population with various outcomes. Therefore, we aimed to evaluate the efficacy of intermittent pneumatic compression (IPC) prophylaxis in the lower limb compared with no treatment, anticoagulant use, or their combinations in reducing risk. A comprehensive electronic database search was conducted for all randomized clinical trials (RCTs) comparing the clinical outcomes of IPC versus anticoagulants or no treatment or their combinations for the prevention of VTE for critically ill patients. The primary outcome was VTE. The secondary outcome was DVT. We performed a Bayesian network meta-analysis to calculate odds ratios (ORs) and 95% credible intervals (CrIs). We included 5 RCTs with 3133 total patients, represented by a mean age of 49.61 ± 18 years, while 60.28% were male. There was a significant reduction of the primary outcome (incidence of VTE events) when no treatment was compared with IPC (OR = 0.36; 95% CrI = 0.18-0.71), anticoagulation alone (OR = 0.30; 95% CrI = 0.12-0.68), or anticoagulation with IPC (OR = 0.34; 95% CrI = 0.13-0.81). In addition, there was a significant reduction in DVT when no treatment was compared with IPC (OR = 0.45; 95% CrI = 0.21-0.9), anticoagulation alone (OR = 0.16; 95% CrI = 0.03-0.66), or anticoagulation with IPC (OR = 0.18; 95% CrI = 0.03-0.84). However, there were no significant differences between other comparisons (IPC vs anticoagulation alone, anticoagulation alone vs anticoagulation with IPC, or anticoagulation with IPC vs IPC alone) regarding VTE or DVT incidence. Among critically ill patients, IPC alone, anticoagulation alone, and IPC with anticoagulation were associated with a significant reduction of VTE and DVT incidence compared with no treatment. However, there was no significant difference between these modalities when compared together. Therefore, further larger studies comparing those different thromboprophylaxis modalities and their combinations are needed to provide more robust results for future clinical recommendations.

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“…The organized and sequential approach to the bleeding patient, guided by POCT allows for rapid and effective bleeding control, through the rational use of blood components and hemostatic drugs, since VET can identify specific coagulation disorders in real time, guiding hemostatic therapy with coagulation factor concentrates and hemostatic drugs with individual goals. (Anesth Analg 2024;138:499-513) 1 Among them, the main cause of death in the world is thrombosis. However, there is concern about the risk of bleeding in patients who have pathological results from conventional coagulation tests (CCTs).…”

mentioning

confidence: 99%

“…Hemorrhage and thrombosis are frequent complications in the intensive care unit (ICU), compromising the clinical outcome of patients. 1 Among them, the main cause of death in the world is thrombosis. However, there is concern about the risk of bleeding in patients who have pathological results from conventional coagulation tests (CCTs).…”

mentioning

confidence: 99%

Early Goal-Directed Hemostatic Therapy for Severe Acute Bleeding Management in the Intensive Care Unit: A Narrative Review

Crochemore,

Görlinger,

Lance

2023

Anesthesia &Amp; Analgesia

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This is a narrative review of the published evidence for bleeding management in critically ill patients in different clinical settings in the intensive care unit (ICU). We aimed to describe “The Ten Steps” approach to early goal-directed hemostatic therapy (EGDHT) using point-of-care testing (POCT), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational studies, and case reports were reviewed. Data related to study methodology, patient population, bleeding management strategy, and clinical outcomes were qualitatively evaluated. According to systematic reviews and meta-analyses, EGDHT guided by viscoelastic testing (VET) has been associated with a reduction in transfusion utilization, improved morbidity and outcome in patients with active bleeding. Furthermore, literature data showed an increased risk of severe adverse events and poor clinical outcomes with inappropriate prophylactic uses of blood components to correct altered conventional coagulation tests (CCTs). Finally, prospective, randomized, controlled trials point to the role of goal-directed fibrinogen substitution to reduce bleeding and the amount of red blood cell (RBC) transfusion with the potential to decrease mortality. In conclusion, severe acute bleeding management in the ICU is still a major challenge for intensive care physicians. The organized and sequential approach to the bleeding patient, guided by POCT allows for rapid and effective bleeding control, through the rational use of blood components and hemostatic drugs, since VET can identify specific coagulation disorders in real time, guiding hemostatic therapy with coagulation factor concentrates and hemostatic drugs with individual goals.

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Thrombosis and Hemostasis Issues in Critically Ill Patients

Cited by 6 publications

References 12 publications

Platelets in Critical Illness

Platelets in Critical Illness

Meta-Analysis of the Role of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients

Early Goal-Directed Hemostatic Therapy for Severe Acute Bleeding Management in the Intensive Care Unit: A Narrative Review

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