Medical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France.
Crit Care. 2023 Aug 9;27(1):312. doi: 10.1186/s13054-023-04605-4.
Anticoagulants 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.
A 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.
486 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.
Anticoagulant-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.
抗凝剂被广泛应用，但可能导致医源性出血等不良事件。目前关于因严重抗凝相关颅外出血而入住重症监护病房（ICU）的患者的特征和处理方法的数据有限。
本研究在法国的 5 家 ICU 中进行了一项回顾性观察性研究。2007 年 1 月至 2018 年 12 月，所有年龄＞18 岁、因接受治疗性抗凝而发生颅外出血且入住 ICU 的患者均被纳入研究。
共纳入 486 例患者，主要为男性（61%），平均年龄为 73±13 岁。大多数患者患有合并症，包括高血压（68%）、心脏病（49%）和糖尿病（33%）。患者接受维生素 K 拮抗剂（VKA，54%）、肝素（25%）和直接口服抗凝剂（DOAC，7%）治疗。因抗凝相关出血而入住 ICU 的患者比例从 2007 年的 3.2/1000 人增加到 2018 年的 5.8/1000 人，其中 DOAC 类药物的增加尤其明显。入院时，患者的器官衰竭严重，SOFA 评分（7±4）高，需要血管加压素（31.5%）和有创机械通气（34%）等器官支持治疗。针对抗凝相关出血的特定治疗指南的执行情况总体上较低。ICU 死亡率为 27%。多变量分析显示，有五个因素与死亡率独立相关：慢性高血压、需要血管加压素、意识障碍、高乳酸血症和延长的 aPTT＞1.2。
因抗凝相关颅外出血而需入住 ICU 的患者病情严重，可导致器官衰竭和高死亡率。其发病率正在上升。治疗管理不理想，可以通过教育项目加以改善。
