Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 18:13:891178.
doi: 10.3389/fphar.2022.891178. eCollection 2022.

Associations Between Antithrombosis and Ventilator-Associated Events, ICU Stays, and Mortality Among Mechanically Ventilated Patients: A Registry-Based Cohort Study

Mingqi Wang  1   2   3 , Wen Wang  1   2   3 , Xue Jia  1   4 , Qiao He  1   2   3 , Shichao Zhu  5 , Yan Kang  6 , Rui Zhang  7 , Yan Ren  1   2   3 , Ling Li  1   2   3 , Kang Zou  1   2   3 , Zhiyong Zong  5   8 , Xin Sun  1   2   3
Affiliations

Associations Between Antithrombosis and Ventilator-Associated Events, ICU Stays, and Mortality Among Mechanically Ventilated Patients: A Registry-Based Cohort Study

Mingqi Wang et al. Front Pharmacol. .

Abstract

Background: The effect of thromboembolism prophylaxis on clinical outcomes, such as ventilator-associated events (VAEs), ICU stays, and mortality, remains controversial. This study was conducted to evaluate the effect of pharmacological thromboprophylaxis on VAEs, ICU stays, and ICU mortality among patients receiving mechanical ventilation (MV). Materials and Methods: A retrospective cohort study was conducted based on a well-established registry of healthcare-associated infections at ICUs in the West China Hospital system. Patients who consistently received MV for at least 4 days from 1 April 2015 to 31 December 2018 were included. Hazard ratios (HRs) were compared for three tiers of VAEs, ICU stays, and ICU mortality among patients receiving pharmacological thromboprophylaxis versus those without using the time-dependent Cox model. For the analyses of ICU stays and ICU mortality, we also used Fine-Gray models to disentangle the competing risks and outcomes of interest. Results: Overall, 6,140 patients were included. Of these, 3,805 received at least one prescription of antithrombosis agents. Treatments with antithrombosis agents were associated with lower risk of VAEs (HR: 0.87, 95% CI: 0.77, 0.98) and ICU mortality (HR: 0.72, 95% CI: 0.61, 0.86) than those without. Anticoagulants but not antiplatelet agents were associated with decreased risk of VAEs (HR: 0.86, 95% CI: 0.75, 0.98), ICU mortality (HR: 0.62, 95% CI: 0.51, 0.76), and less time to ICU discharge (HR: 1.15, 95% CI: 1.04, 1.28). Antithrombosis may be associated with decreased risk of VAEs in patients with D-dimer >5 mg/LFEU (HR: 0.84, 95%CI: 0.72, 0.98). Conclusions: Pharmacological thromboprophylaxis was associated with lower risk of VAEs and ICU mortality. Similar effects were observed between unfractionated heparins versus low-molecular-weight heparins.

Keywords: ICU mortality; antithrombosis prophylaxis; patients receiving mechanical ventilation; ventilator-associated events; ventilator-associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study flow chart. ICU: intensive care units; MV: Mechanical ventilation; PEEP: Positive end-expiratory pressure; FIO2: Fraction of inspired oxygen; VAE: Ventilator-associated events
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Al Yami M. S., Silva M. A., Donovan J. L., Kanaan A. O. (2017). Venous Thromboembolism Prophylaxis in Medically Ill Patients: a Mixed Treatment Comparison Meta-Analysis. J. Thromb. Thrombolysis 45 (1), 36–47. 10.1007/s11239-017-1562-5 - DOI - PubMed
    1. Alhazzani W., Lim W., Jaeschke R. Z., Murad M. H., Cade J., Cook D. J. (2013). Heparin Thromboprophylaxis in Medical-Surgical Critically Ill Patients: a Systematic Review and Meta-Analysis of Randomized Trials. Crit. Care Med. 41 (9), 2088–2098. 10.1097/CCM.0b013e31828cf104 - DOI - PubMed
    1. Attia J., Ray J. G., Cook D. J., Douketis J., Ginsberg J. S., Geerts W. H. (2001). Deep Vein Thrombosis and its Prevention in Critically Ill Adults. Arch. Intern Med. 161 (10), 1268–1279. 10.1001/archinte.161.10.1268 - DOI - PubMed
    1. Bajaj N. S., Vaduganathan M., Qamar A., Gupta K., Gupta A., Golwala H., et al. (2019). Extended Prophylaxis for Venous Thromboembolism after Hospitalization for Medical Illness: A Trial Sequential and Cumulative Meta-Analysis. PLoS Med. 16, e1002797. 10.1371/journal.pmed.1002797 - DOI - PMC - PubMed
    1. Barrera L. M., Perel P., Ker K., Cirocchi R., Farinella E., Morales Uribe C. H. (2010). Thromboprophylaxis for Trauma Patients. Cochrane Database Syst. Rev. 2010 (3), CD008303. 10.1002/14651858.CD008303.pub2 - DOI - PubMed