Abstract
Objective: This study was aimed to assess the incidence of bleeding and factors associated with bleeding among critically ill medical patients on anticoagulant prophylaxis in the intensive care unit (ICU).
Design: Observational study conducted over a period of 18 months.
Setting: Multi-disciplinary ICU of a tertiary care center in South India.
Patients and participants: Patients aged >18 years admitted to the ICU satisfying the inclusion and exclusion criteria.
Methods: All critically ill medical patients on pharmacological prophylaxis for deep vein thrombosis (unfractionated heparin [UFH] or low molecular weight heparin) were included in this study. Patients with proven thrombosis, active bleeding, surgical or trauma patients, pregnant, and lactating women were excluded from the study. The outcome was categorized as presence or absence of bleeding. Factors associated with bleeding, the pattern of bleeding among study participants were compared between bleeders and non-bleeders.
Results: A total of 490 patients were studied and the incidence of bleeding observed was 5.9% (n=29). Among those who had bleeding (n=29), 8 patients had major bleeding and 21 patients had minor bleeding. Use of enoxaparin or UFH was not significantly associated with bleeding risk (p-value=0.692). The presence of coronary artery disease (CAD) and baseline prolongation in activated partial thromboplastin time (aPTT) were significantly associated with risk for bleeding among medically ill patients on pharmacological prophylaxis in ICU (p-value=0.023, p-value=0.002, respectively). The most common site of bleeding noted was from the urinary tract (n=11) followed by endotracheal tube bleed (n=4). Four patients died in the group who had major bleeding.
Conclusion: The use of anticoagulants for thromboprophylaxis was associated with bleeding and bleeding rates were similar between UFH and low molecular weight heparin (enoxaparin). Underlying comorbid illnesses like CAD and baseline elevated aPTT were associated with a significant risk of bleeding in ICU patients on pharmacological prophylaxis for DVT.
Gowtam Mukhesh, Sudha Madhavan, Viswanathan Pandurangan, Devasena Srinivasan, Emmanuel Bhaskar, Lakshmi Marappa
