Venous Thromboembolism in ICU Patients with Intracerebral Hemorrhage: Risk Factors and the Prognosis After Anticoagulation Therapy
Quanhong Chu, Lin Liao, Wenxin Wei, Ziming Ye, Li Zeng, Chao Qin, Yanyan Tang
Abstract
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.