DVT and Bleeding Risks in ICU Patients with Kidney Issues
Author Information
Author(s): Deborah Cook, James Douketis, Maureen Meade, Gordon Guyatt, Nicole Zytaruk, John Granton, Yoanna Skrobik, Martin Albert, Robert Fowler, Paul Hebert, Giuseppe Pagliarello, Jan Friedrich, Andreas Freitag, Tim Karachi, Christian Rabbat, Diane Heels-Ansdell, William Geerts, Mark Crowther
Primary Institution: McMaster University
Hypothesis
The study aimed to evaluate the prevalence, incidence, and predictors of DVT and major bleeding in ICU patients with severe renal insufficiency receiving dalteparin.
Conclusion
In ICU patients with renal insufficiency, the incidence of DVT and major bleeding are considerable but appear related to patient comorbidities rather than to an inadequate or excessive anticoagulant effect from thromboprophylaxis with dalteparin.
Supporting Evidence
- DVT developed in 5.1% of patients.
- Major bleeding developed in 7.2% of patients.
- The only independent risk factor for DVT was a high baseline Acute Physiology and Chronic Health Evaluation II score.
- Independent risk factors for major bleeding included aspirin use and a high International Normalized Ratio.
Takeaway
Patients in the ICU with kidney problems can get blood clots and bleeding, but it's mostly because of their other health issues, not the medicine they take to prevent these problems.
Methodology
This was a multicenter, open-label, prospective cohort study assessing thromboprophylaxis with dalteparin in critically ill patients with severe renal insufficiency.
Potential Biases
The study was open-label, which may introduce bias in outcome assessment.
Limitations
The sample size may limit the power of regression analysis to identify risk factors, and screening was only for lower extremity DVT, potentially underestimating the overall DVT rate.
Participant Demographics
{"mean_age":68.3,"female_percentage":55.8,"renal_classification":{"acute_renal_failure":61.6,"acute_on_chronic":23.2,"chronic_renal_failure":6.5,"chronic_dialysis":8.7}}
Statistical Information
Confidence Interval
{"DVT":"95% CI, 2.5 to 10.1","major_bleeding":"95% CI, 4.0 to 12.8"}
Digital Object Identifier (DOI)
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