Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study

Carini, FC; Angriman, F; Scales, DC; Munshi, L; Burry, LD; Sibai, H; Mehta, S; Ferreyro, BL; SELECTION study group

doi:10.1007/s00134-023-07287-2

ICU sedation, delirium & recovery

Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study

Intensive Care MedPublished 3 Jan 2024Population-based cohort study

Main finding · Incidence of VTEResultOdds ratio 3.08 95% CI 2.77–3.42

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Authors' conclusion

Among patients with hematologic malignancy, critical illness and certain baseline characteristics were associated with a higher incidence of VTE.

Study context

Population: Hospitalised adults with a new diagnosis of hematologic malignancy, Ontario, Canada, 2006–2017
Participants: 76,803 eligible patients

Exposure: Intensive care unit (ICU) vs non-ICU patients
ICUn = 20,524
Outcome: VTE (pulmonary embolism or deep venous thrombosis)

Main finding

Incidence of VTE

Odds ratio

3.08

95% CI 2.77–3.42

By group

ICU3.7%

Non-ICU1.2%

ICU vs Non-ICU

OR 3.08 (95% CI 2.77–3.42)

As reported in the abstract

Association of critical illness and venous thromboembolism (VTE) remained significant after adjusting for potential confounders: OR 2.92; 95% CI 2.62-3.25

Observational data: associations, not effects.

Secondary outcomes

Outcome	ICU	Non-ICU	← Lower odds with ICU ←→ Higher odds with ICU →	OR (95% CI)
Incidence of major bleeding	7.6%	2.4%	0.20.5125	3.33 (3.09–3.58)
			0.20.5125Odds ratio (log scale)

VTE by baseline characteristics

Higher incidence of VTE in patients with prior VTE: OR 6.64; 95% CI 5.42-8.14
Admission more than 1 year after diagnosis of hematologic malignancy associated with lower incidence of VTE: OR 0.64; 95% CI 0.56-0.74
Platelet count ≤ 50 × 109/L at the time of hospitalization associated with lower incidence of VTE: OR 0.63; 95% CI 0.48-0.84
Higher incidence of VTE among specific subtypes of hematologic malignancy

Safety

Outcome	ICU	Non-ICU	← Lower odds with ICU ←→ Higher odds with ICU →	OR (95% CI)
Major bleeding	7.6%	2.4%	0.20.5125	3.33 (3.09–3.58)
			0.20.5125Odds ratio (log scale)

Original publication

Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study. Intensive Care Med. Published 3 January 2024. doi:10.1007/s00134-023-07287-2

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