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Venous Thromboembolism in ICU Patients with Intracerebral Hemorrhage: Risk Factors and the Prognosis After Anticoagulation Therapy
International Journal of General Medicine ( IF 2.3 ) Pub Date : 2021-09-08 , DOI: 10.2147/ijgm.s327676 Quanhong Chu 1 , Lin Liao 2 , Wenxin Wei 1 , Ziming Ye 1 , Li Zeng 1 , Chao Qin 1 , Yanyan Tang 1
International Journal of General Medicine ( IF 2.3 ) Pub Date : 2021-09-08 , DOI: 10.2147/ijgm.s327676 Quanhong Chu 1 , Lin Liao 2 , Wenxin Wei 1 , Ziming Ye 1 , Li Zeng 1 , Chao Qin 1 , Yanyan Tang 1
Affiliation
Purpose: Venous thromboembolism (VTE) is a common complication of intracerebral hemorrhage (ICH) patients in intensive care unit (ICU), but anticoagulation therapy of ICH patients with VTE remains controversial. We aim to explore the risk factors and prognosis of anticoagulation therapy in ICH patients with VTE.
Patients and Methods: Medical records of ICH patients were collected from the Medical Information Mart for Intensive Care III (MIMIC-III version 1.4) database. The risk factors and prognosis of anticoagulation therapy in ICH patients with VTE were assessed by multivariable logistic regression analysis and Kaplan–Meier survival analysis, respectively.
Results: A total of 848 ICH patients were included in our study, of whom 69 ICH patients with VTE were screened, including 58 patients with deep vein thrombosis (DVT), 12 patients with pulmonary embolism (PE), and 1 patient with DVT and PE. In the multivariable logistic regression analysis, malignancy (odds ratio (OR): 4.262, 95% confidence interval (CI): 2.263– 8.027, P=0.000), pulmonary circulation disease (OR: 28.717, 95% CI: 9.566– 86.208, P=0.000), coagulopathy (OR: 2.453, 95% CI: 1.098– 5.483, P=0.029), age > 60 years old (OR: 2.138, 95% CI: 1.087– 4.207, P=0.028) and hospitalization time > 16 days (OR: 2.548, 95% CI: 1.381– 4.701, P=0.003) were independent risk factors for VTE in ICH patients. Kaplan–Meier survival analysis and log-rank test found that, compared to non-anticoagulation group, anticoagulation group had higher cumulative survival rates during hospitalization, 28-day, 3-month, 1-year, and 4-year after admission, respectively.
Conclusion: Malignancy, pulmonary circulation disease, coagulopathy, age > 60 years old and hospitalization time > 16 days were independent risk factors for VTE in ICH patients, and anticoagulation therapy for VTE in ICH patients may be safe and effective. These findings need to be verified by more high-quality and well-designed randomized controlled trials.
Keywords: intracerebral hemorrhage, venous thromboembolism, risk factors, anticoagulation, prognosis
中文翻译：
ICU脑出血患者的静脉血栓栓塞：危险因素和抗凝治疗后的预后
目的：静脉血栓栓塞（VTE）是重症监护病房（ICU）脑出血（ICH）患者的常见并发症，但对ICH合并VTE患者的抗凝治疗仍存在争议。我们旨在探讨 ICH 合并 VTE 患者抗凝治疗的危险因素和预后。
患者和方法： ICH 患者的医疗记录从重症监护医疗信息集市 III（MIMIC-III 版本 1.4）数据库中收集。分别通过多变量逻辑回归分析和Kaplan-Meier生存分析评估ICH合并VTE患者抗凝治疗的危险因素和预后。
结果：本研究共纳入848例ICH患者，其中69例合并VTE的ICH患者进行筛查，其中深静脉血栓形成（DVT）58例，肺栓塞（PE）12例，DVT合并PE患者1例。在多变量逻辑回归分析中，恶性肿瘤（优势比（OR）：4.262，95% 置信区间（CI）：2.263-8.027，P=0.000），肺循环疾病（OR：28.717，95% CI：9.566-86.208， P=0.000)、凝血功能障碍 (OR: 2.453, 95% CI: 1.098–5.483, P=0.029)、年龄 > 60 岁 (OR: 2.138, 95% CI: 1.087–4.207, P=0.028) 和住院时间 > 16 天（OR：2.548，95% CI：1.381-4.701，P=0.003）是 ICH 患者 VTE 的独立危险因素。Kaplan-Meier 生存分析和时序检验发现，与非抗凝组相比，
结论：恶性肿瘤、肺循环疾病、凝血功能障碍、年龄>60岁、住院时间>16天是ICH患者VTE发生的独立危险因素，ICH患者VTE的抗凝治疗可能是安全有效的。这些发现需要通过更多高质量和设计良好的随机对照试验来验证。
【关键词】：脑出血 静脉血栓栓塞 危险因素 抗凝治疗 预后
更新日期：2021-09-07
Patients and Methods: Medical records of ICH patients were collected from the Medical Information Mart for Intensive Care III (MIMIC-III version 1.4) database. The risk factors and prognosis of anticoagulation therapy in ICH patients with VTE were assessed by multivariable logistic regression analysis and Kaplan–Meier survival analysis, respectively.
Results: A total of 848 ICH patients were included in our study, of whom 69 ICH patients with VTE were screened, including 58 patients with deep vein thrombosis (DVT), 12 patients with pulmonary embolism (PE), and 1 patient with DVT and PE. In the multivariable logistic regression analysis, malignancy (odds ratio (OR): 4.262, 95% confidence interval (CI): 2.263– 8.027, P=0.000), pulmonary circulation disease (OR: 28.717, 95% CI: 9.566– 86.208, P=0.000), coagulopathy (OR: 2.453, 95% CI: 1.098– 5.483, P=0.029), age > 60 years old (OR: 2.138, 95% CI: 1.087– 4.207, P=0.028) and hospitalization time > 16 days (OR: 2.548, 95% CI: 1.381– 4.701, P=0.003) were independent risk factors for VTE in ICH patients. Kaplan–Meier survival analysis and log-rank test found that, compared to non-anticoagulation group, anticoagulation group had higher cumulative survival rates during hospitalization, 28-day, 3-month, 1-year, and 4-year after admission, respectively.
Conclusion: Malignancy, pulmonary circulation disease, coagulopathy, age > 60 years old and hospitalization time > 16 days were independent risk factors for VTE in ICH patients, and anticoagulation therapy for VTE in ICH patients may be safe and effective. These findings need to be verified by more high-quality and well-designed randomized controlled trials.
Keywords: intracerebral hemorrhage, venous thromboembolism, risk factors, anticoagulation, prognosis
中文翻译：
ICU脑出血患者的静脉血栓栓塞：危险因素和抗凝治疗后的预后
目的：静脉血栓栓塞（VTE）是重症监护病房（ICU）脑出血（ICH）患者的常见并发症，但对ICH合并VTE患者的抗凝治疗仍存在争议。我们旨在探讨 ICH 合并 VTE 患者抗凝治疗的危险因素和预后。
患者和方法： ICH 患者的医疗记录从重症监护医疗信息集市 III（MIMIC-III 版本 1.4）数据库中收集。分别通过多变量逻辑回归分析和Kaplan-Meier生存分析评估ICH合并VTE患者抗凝治疗的危险因素和预后。
结果：本研究共纳入848例ICH患者，其中69例合并VTE的ICH患者进行筛查，其中深静脉血栓形成（DVT）58例，肺栓塞（PE）12例，DVT合并PE患者1例。在多变量逻辑回归分析中，恶性肿瘤（优势比（OR）：4.262，95% 置信区间（CI）：2.263-8.027，P=0.000），肺循环疾病（OR：28.717，95% CI：9.566-86.208， P=0.000)、凝血功能障碍 (OR: 2.453, 95% CI: 1.098–5.483, P=0.029)、年龄 > 60 岁 (OR: 2.138, 95% CI: 1.087–4.207, P=0.028) 和住院时间 > 16 天（OR：2.548，95% CI：1.381-4.701，P=0.003）是 ICH 患者 VTE 的独立危险因素。Kaplan-Meier 生存分析和时序检验发现，与非抗凝组相比，
结论：恶性肿瘤、肺循环疾病、凝血功能障碍、年龄>60岁、住院时间>16天是ICH患者VTE发生的独立危险因素，ICH患者VTE的抗凝治疗可能是安全有效的。这些发现需要通过更多高质量和设计良好的随机对照试验来验证。
【关键词】：脑出血 静脉血栓栓塞 危险因素 抗凝治疗 预后
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