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Thromboprophylaxis, Delta Sofa and Main Outcomes in Ventilated Patients: an Analysis of the MIMIC-III Clinical Database
Mrigendra Mani Bastola
National Library of Medicine, National Institutes of Health, Bethesda, MD 20894.
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5696-674X
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This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners.
Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT).
Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia, which required platelet transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)).
Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). Heparin is related to both higher episodes of platelets transfusion and improvement of delta SOFA scores at end of first week of ICU admission. If validated by future research, the findings of this study might help practitioners and researchers to better understand thromboprophylaxis in ventilated patients.
Keywords
Critical care patients, thromboprophylaxis, MIMIC-III clinical database
Figure 1
Figure 2
Due to technical limitations, table 1-4 is only available as a download in the Supplemental Files section.
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryDiagram1.pdf
- Table4.pdf
Table 4: Adjusted Odds ratios for Heparin, Warfarin, Enoxaparin and Aspirin for ICU mortality, overall hospital mortality, thrombocytopenia episodes requiring platelets transfusion, and improvement in SOFA scores at 4,7 and 10 days in ICU stay.
- Table1.pdf
Table 1: Relevant demographics, census and ICU parameters of the included patients.
- Table3.pdf
Table 3: Hazard ratio calculations for Heparin, Warfarin, Enoxaparin and Aspirin for ICU length of stay, hospital length of stay, ventilation duration, PE and DVT events after start of prophylaxis.
- Table2.pdf
Table 2: Odds ratio calculations for most used thromboprophylaxis agents for pulmonary embolism, deep venous thrombosis, and cases with elevated D-dimer levels.
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Research
Thromboprophylaxis, Delta Sofa and Main Outcomes in Ventilated Patients: an Analysis of the MIMIC-III Clinical Database
Mrigendra Mani Bastola
National Library of Medicine, National Institutes of Health, Bethesda, MD 20894.
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5696-674X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 22 Sep, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners.
Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT).
Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia, which required platelet transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)).
Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). Heparin is related to both higher episodes of platelets transfusion and improvement of delta SOFA scores at end of first week of ICU admission. If validated by future research, the findings of this study might help practitioners and researchers to better understand thromboprophylaxis in ventilated patients.
Figure 1
Figure 2
Due to technical limitations, table 1-4 is only available as a download in the Supplemental Files section.