Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA.
Department of Surgery, Saint Francis Hospital, Trinity Health of New England, Hartford, CT, USA.
World J Surg. 2022 Nov;46(11):2625-2631. doi: 10.1007/s00268-022-06662-2. Epub 2022 Jul 19.
Bedside percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) are common procedures performed in the intensive care unit (ICU). Venous thromboembolism (VTE) prophylaxis is frequently prescribed to ICU patients and it remains unclear whether pre-procedure discontinuation is necessary.
This multi-center prospective observational study aimed to describe bleeding rates in patients undergoing bedside PEG or PDT who did or did not have VTE prophylaxis held. Decision to hold prophylaxis was made by the operating physician. The primary endpoint was the rate of peri-procedural bleeding complications. Secondary endpoints included quantification of held doses in the peri-procedural period, rate of venous thromboembolism, and characteristics associated with having prophylaxis held.
91 patients were included over a 2-year period. Patients were on average aged 54 years, 40% female, mostly admitted to the trauma service (59%), and most commonly underwent bedside PDT (59%). Overall, 21% of patients had doses of pre-procedure prophylaxis held. Bleeding events occurred in 1 patient (1.4%) who had prophylaxis continued and in 1 patient (5.0%) who had prophylaxis held, a rate difference of 3.6% (95% CI-9.5%, 16.7%). One bleeding event was managed with bedside surgical repair and one with blood transfusion. There were 10 VTE events, all of whom had prophylaxis continued during the pre-procedure period but 3 had prophylaxis held after the procedure.
Bleeding complications were rare and did not significantly differ depending on whether prophylaxis was held or not. Future research is required to confirm the lack of risk with continuing prophylaxis through bedside procedures.
床边经皮扩张气管切开术（PDT）和经皮内镜下胃造口术（PEG）是重症监护病房（ICU）中常见的操作。静脉血栓栓塞症（VTE）预防措施经常用于 ICU 患者，但目前仍不清楚是否需要在操作前停药。
本多中心前瞻性观察研究旨在描述接受床边 PEG 或 PDT 的患者中，继续或不继续 VTE 预防治疗的患者的出血率。停药决策由操作医生做出。主要终点是围手术期出血并发症的发生率。次要终点包括围手术期停用的预防剂量、静脉血栓栓塞症的发生率以及与预防治疗停药相关的特征。
在 2 年期间共纳入 91 例患者。患者平均年龄为 54 岁，40%为女性，主要收入创伤科（59%），最常进行床边 PDT（59%）。总体而言，21%的患者停止了术前预防治疗。继续预防治疗的患者中有 1 例（1.4%）发生出血事件，停止预防治疗的患者中有 1 例（5.0%）发生出血事件，发生率差异为 3.6%（95%CI-9.5%，16.7%）。1 例出血事件经床边手术修复，1 例接受输血治疗。有 10 例 VTE 事件，所有患者在术前期间均继续接受预防治疗，但 3 例在术后期间停止了预防治疗。
出血并发症罕见，与是否停药无关。需要进一步研究来确认继续通过床边操作进行预防治疗并无风险。
