Common haemostasis issues in major bleeding and critical illness

Gulati, Divyansh; Novak, Alex; Stanworth, Simon

doi:10.7861/clinmedicine.18-4-320

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…Similar to ischemic risk, bleeding risk in this setting appears to be greater than that reported in patients with AMI in cardiology wards (≃ 5%) [ 37 ]. The dysregulated infection-inflammation immune response may produce antithrombotic states with thrombocytopenia, decreased clotting factors, and increased fibrinolysis, which predispose to bleeding complications [ 38 – 41 ]. Several studies have developed predictive instruments for the estimation of bleeding risk in patients with AMI in cardiology wards [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

Roué,

Guédon,

Lapidus

et al. 2023

Ann. Intensive Care

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Background Acute myocardial infarction (AMI) is one of the major cardiac complications in patients hospitalized in the intensive care unit (ICU) for non-cardiac disease. A better knowledge of ischemic and bleeding risks in these patients is needed to identify those most likely to benefit from specific cardiac management. We therefore assessed the incidence and predictors of a composite outcome of severe ischemic event (AMI recurrence, ischemic stroke), major bleeding, or all-cause death in this setting. Methods In this multicenter retrospective study, all consecutive adult patients admitted for non-cardiac disease to four French university hospital ICUs between January 2012 and December 2018 who had an AMI with obstructive coronary artery disease (OCAD) during the ICU stay were considered for inclusion. AMI with OCAD was defined as an elevated cardiac troponin value associated with at least one sign (clinical, electrocardiographic, or echocardiographic) suggestive of myocardial ischemia and presence of OCAD on coronary angiography. The primary endpoint was in-hospital occurrence of the composite outcome. Results Ninety-six patients [median age 69 years, 22 women (23%), 59 with sepsis (61%), 35 with ST elevation (37%), median sequential organ failure assessment (SOFA) of 8 on the day of AMI] were included. The median peak cardiac troponin value was 131 (IQR 44–303) times the upper reference limit. Dual antiplatelet, therapeutic anticoagulation, and early mechanical reperfusion therapies were administered in 61 (64%), 68 (71%), and 47 (49%) patients, respectively. The composite outcome occurred in 48 (50%) patients. Severe ischemic events occurred in 17 (18%) patients and major bleeding in 26 (27%) patients; 26 patients (27%) died in the hospital. AMI management was not significantly different in patients with and without the composite outcome. A history of arterial hypertension (HR 2.05, 95% CI 1.01–4.16) and high SOFA score at the time of AMI (HR 1.07, 95% CI 1.00–1.15) were independent risk factors for the composite outcome. Conclusions Patients who have an AMI with OCAD during an ICU stay for non-cardiac disease are at risk of a composite outcome of severe ischemia, major bleeding, and death. A history of arterial hypertension and high SOFA scores were independent hazards for poor prognosis. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

Roué,

Guédon,

Lapidus

et al. 2023

Ann. Intensive Care

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“…Various coagulation disorders are seen in critically ill and trauma patients, acute traumatic coagulopathy and disseminated intravascular coagulation, being the most common disorders. 3 A variety of tests have now become available to diagnose coagulation disorders. 4 In this issue, we deal with discussions ranging from physiology of oxygen transport, various tests used for diagnosis and management of coagulation disorders, to topics such as auditing transfusion practice, guidelines for infusion of blood products, etc.…”

Section: Big Things Have Small Beginnings! -Prometheusmentioning

confidence: 99%

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confidence: 99%

Success is the Sum of Small Efforts!

Kulkarni

Samavedam

Hegde

2019

Indian Journal of Critical Care Medicine

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“…10 These advances have led to an increasingly complicated decision-making process, reflected by the complex impact that hemostatic imbalance can have on the complement system, immunity, and inflammation and, therefore, the management of hemostatic disorders. 11,12 This situation is compounded, in some instances, where access to even basic laboratory testing and medications is limited, 13 as are opportunities to access the latest scientific knowledge, tests, devices, or medications, compromising provision of optimal clinical care. 14 Given this rapidly evolving context, educational activities are needed to ensure optimal knowledge dissemination to T&H professionals.…”

Section: Introductionmentioning

confidence: 99%

Needs and challenges among physicians and researchers in thrombosis and hemostasis: Results from an international study

Murray

McLintock

Lazure

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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BackgroundSpecialty societies, such as the International Society on Thrombosis and Haemostasis (ISTH), are a key source of support for clinical and scientific communities, through the provision of educational activities, tools, and resources to support evidence‐based care and high‐quality, relevant basic science and clinical research.ObjectiveThe aim of this study was to identify areas where the thrombosis and hemostasis (T&H) community is facing challenges and could benefit from the support of ISTH.MethodsA 3‐phase, mixed‐methods study consisting of semistructured individual interviews (phase 1), an online survey (phase 2), and discussion groups (phase 3) was conducted on the challenges experienced by the T&H community. Participants included physicians, clinical and basic science researchers, residents, fellows, students, and industry representatives. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed using frequency tables and chi‐squares.ResultsThe study included 468 participants in interviews (n = 45), surveys (n = 404), and discussion groups (n = 19). Nine themes emerged that describe areas where the T&H community may benefit from additional support. Three areas were related to diagnosis and testing: thrombosis risk assessment, genetic testing, and diagnosis of von Willebrand disease (VWD). Another 3 were related to treatment decision making: use of anticoagulants with certain patients, preventive treatments in bleeding disorders, and VWD treatment. The remaining 3 were related to research: collaboration with/among researchers, collaboration between teams to collect data from human subjects, and promotion of basic science research.ConclusionsThis study provides a comprehensive picture of priorities within the T&H community, which should inform the ISTH in its future interventions, including educational offerings and networking opportunities.

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Common haemostasis issues in major bleeding and critical illness

Cited by 7 publications

References 25 publications

In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

Success is the Sum of Small Efforts!

Needs and challenges among physicians and researchers in thrombosis and hemostasis: Results from an international study

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