Frontiers in Pharmacology (Jul 2022)

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

  • Mingqi Wang,
  • Mingqi Wang,
  • Mingqi Wang,
  • Wen Wang,
  • Wen Wang,
  • Wen Wang,
  • Xue Jia,
  • Xue Jia,
  • Qiao He,
  • Qiao He,
  • Qiao He,
  • Shichao Zhu,
  • Yan Kang,
  • Rui Zhang,
  • Yan Ren,
  • Yan Ren,
  • Yan Ren,
  • Ling Li,
  • Ling Li,
  • Ling Li,
  • Kang Zou,
  • Kang Zou,
  • Kang Zou,
  • Zhiyong Zong,
  • Zhiyong Zong,
  • Xin Sun,
  • Xin Sun,
  • Xin Sun

DOI
https://doi.org/10.3389/fphar.2022.891178
Journal volume & issue
Vol. 13

Abstract

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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.

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