Alshehri Abdulmajeed M, Alrashed Mohammed, Alzahrani Mohammed, Alsuwaylihi Abdulmajeed, Alarifi Abdulaziz, Althobiti Faris, Al Yami Majed S
Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3360, Riyadh, 11481, 3163, Saudi Arabia.
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
Thromb J. 2025 Mar 10;23(1):20. doi: 10.1186/s12959-025-00703-1.
Direct oral anticoagulants (DOACs) are widely used as first-line agents in various clinical settings. However, there is very little evidence regarding their use in critically ill patients in the intensive care unit (ICU), given the gap in the literature regarding their safety in this population and the concerns of bleeding and alterations in pharmacokinetics. Therefore, this study aimed to evaluate the prescribing pattern and safety of DOAC use in critically ill patients.
This was a single-centre retrospective chart review study involving critically ill patients with confirmed prehospital use of DOACs who either continued their use of DOACs or switched to a therapeutic parenteral anticoagulant agent (enoxaparin or heparin) during the admission to the medical ICU and/or coronary care unit (CCU). The primary outcome was the incidence of major bleeding (MB) events. The secondary outcomes included the incidence of new thrombosis and medical ICU/CCU mortality and hospital and medical ICU/CCU lengths of stay (LOS).
A total of 675 patients were screened for inclusion. A total of 302 patients were included in the final analysis, with 167 patients in the DOAC group and 135 patients in the parenteral anticoagulant group. There were no differences between the groups in terms of the incidence of MB (11% vs. 9%, p = 0.61) or new thrombosis (1% vs. 3%, p = 0.50). The overall medical ICU/CCU mortality rate was lower in the DOAC group compared to the parenteral anticoagulant group (7% vs. 15%, p = 0.03). Additionally, the DOAC group had shorter medical ICU/CCU stays (6 days [4-11] vs. 11 days [5-24], p < 0.001) and shorter hospital stays (7 days [5-13] vs. 13 days [7-35], p < 0.001), respectively.
Compared with the use of parenteral anticoagulants, the use of DOACs in critically ill patients was associated with a similar incidence of MB and new thrombotic events. The observed differences in mortality and LOS between the groups may be attributed to variability in physician decision-making regarding anticoagulation strategies, potentially influenced by patient-specific factors and severity of illness. Further prospective studies to determine the optimal anticoagulation strategy in critically ill patients are warranted.
直接口服抗凝剂（DOACs）在各种临床环境中被广泛用作一线药物。然而，鉴于文献中关于其在重症监护病房（ICU）重症患者中使用安全性的空白以及对出血和药代动力学改变的担忧，关于其在ICU重症患者中的使用证据非常少。因此，本研究旨在评估DOACs在重症患者中的处方模式和安全性。
这是一项单中心回顾性病历审查研究，纳入了在院前已确诊使用DOACs的重症患者，这些患者在入住内科ICU和/或冠心病监护病房（CCU）期间继续使用DOACs或改用治疗性肠外抗凝剂（依诺肝素或肝素）。主要结局是大出血（MB）事件的发生率。次要结局包括新血栓形成的发生率、内科ICU/CCU死亡率以及住院时间和内科ICU/CCU住院时间（LOS）。
共筛选出675例患者纳入研究。最终分析纳入了302例患者，其中DOAC组167例，肠外抗凝剂组135例。两组在MB发生率（11%对9%，p = 0.61）或新血栓形成发生率（1%对3%，p = 0.50）方面无差异。DOAC组的总体内科ICU/CCU死亡率低于肠外抗凝剂组（7%对15%，p = 0.03）。此外，DOAC组的内科ICU/CCU住院时间更短（6天[4 - 11]对11天[5 - 24]，p < 0.001），住院时间也更短（7天[5 - 13]对13天[7 - 35]，p < 0.001）。
与使用肠外抗凝剂相比，DOACs在重症患者中的使用与MB和新血栓形成事件的发生率相似。两组观察到的死亡率和住院时间差异可能归因于医生在抗凝策略决策上的差异，这可能受到患者特定因素和疾病严重程度的影响。有必要进行进一步的前瞻性研究以确定重症患者的最佳抗凝策略。
