Evidence map›Paper›PMID 37559102›Full record

Observational studyCritical care (London, England)2023

Extracranial anticoagulant related bleedings admitted to intensive care units: a French multicenter retrospective study.

Thomas Botrel, Sibylle Cunat, Julie Helms, Jérémie Lemarié, Jeanne Gaillon, Sébastien Préau, Raphael Favory, Arnaud W Thille, Florence Boissier, Eric Maury and 2 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Thomas BotrelMedical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Sibylle CunatUniversité de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France.
Julie HelmsUniversité de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France.
Jérémie LemariéIntensive Care Department, Nantes University Hospital, Nantes, France.
Jeanne GaillonIntensive Care Department, Nantes University Hospital, Nantes, France.
Sébastien PréauIntensive Care Department, CHU Lille, Univ. Lille, RID-AGE, INSERM UMR 1167, Institut Pasteur, 59000, Lille, France.
Raphael FavoryIntensive Care Department, CHU Lille, Univ. Lille, RID-AGE, INSERM UMR 1167, Institut Pasteur, 59000, Lille, France.
Arnaud W ThilleIntensive Care Department, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France.
Florence BoissierIntensive Care Department, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France.
Eric MauryMedical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Jérémie JoffreMedical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Hafid Ait-OufellaMedical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France. hafid.aitoufella@aphp.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnticoagulants are widely used but can lead to iatrogenic events such as bleeding. Limited data exists regarding the characteristics and management of patients admitted to intensive care units (ICU) for severe anticoagulant-related extracranial bleeding.

methodsA retrospective observational study was conducted in five French ICUs. From January 2007 to December 2018, all patients aged over 18 years admitted to ICU for extracranial bleeding while receiving therapeutic anticoagulation were included.

results486 patients were included, mainly male (61%) with an average age of 73 ± 13 years. Most patients had comorbidities, including hypertension (68%), heart disease (49%) and diabetes (33%). Patients were treated by vitamin K antagonists (VKA, 54%), heparins (25%) and direct oral anticoagulants (DOAC, 7%). The incidence of patients admitted to ICU for anticoagulant-related bleeding increased from 3.2/1000 admissions in 2007 to 5.8/1000 in 2018. This increase was particularly high for DOAC class. Upon admission, patients exhibited severe organ failure, as evidenced by a high SOFA score (7 ± 4) and requirement for organ support therapies such as vasopressors (31.5%) and invasive mechanical ventilation (34%). Adherence to guidelines for the specific treatment of anticoagulant-related bleeding was generally low. ICU mortality was 27%. In multivariate analysis, five factors were independently associated with mortality: chronic hypertension, need for vasopressors, impaired consciousness, hyperlactatemia and prolonged aPTT > 1.2.

conclusionAnticoagulant-related extracranial bleeding requiring ICU admission is a serious complication responsible for organ failure and significant mortality. Its incidence is rising. The therapeutic management is suboptimal and could be improved by educational programs.

Indexed as

AnticoagulantsHypertensionAdultAgedAged, 80 and overFemaleHemorrhageHumansIntensive Care UnitsMaleMiddle AgedRetrospective StudiesAnticoagulantsAnticoagulantBleedingICUOutcomeTransfusion

Identifiers

PMID37559102
PMCPMC10411017

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.