Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Critically ill patients with atrial fibrillation are at increased risk of both thromboembolism and bleeding. The optimal anticoagulant strategy in this population and its impact on outcomes is unknown.
Research Question or Hypothesis: Does therapeutic anticoagulation compared to pharmacologic venous thromboembolism (VTE) prophylaxis impact the prevalence of bleeding or thromboembolism in critically ill patients with pre-existing atrial fibrillation?
Study Design: Retrospective cohort study.
Methods: This study assessed adult patients in the medical or cardiac intensive care unit with pre-existing atrial fibrillation who received therapeutic anticoagulation versus VTE prophylaxis. Data extraction occurred via manual chart review. Patients were excluded if they had a non-atrial fibrillation anticoagulation indication, were hypercoagulable, thrombocytopenic, or admitted for bleeding or stroke. The primary outcome was international society of thrombosis and hemostasis defined major and clinically relevant non-major bleeding. Stroke rate was assessed between groups. Group characteristics and outcomes were presented using descriptive statistics with multivariable logistic regression used to adjust for relevant confounders. Alpha was set at < 0.05 and analyses were completed using SAS v9.4.
Results: A total of 199 patients were included, 100 received therapeutic anticoagulation and 99 VTE prophylaxis. Therapeutic anticoagulation mainly included patients receiving a heparin infusion (80%) and prophylactic anticoagulation mainly included subcutaneous heparin (87%). Those on therapeutic anticoagulation compared to VTE prophylaxis had a median (interquartile range) HAS-BLED score of 3 (3-4) versus 3 (2-4) (p=0.0013) and CHA2DS2VASc score of 4 (3-5) versus 4 (2-5) (p=0.5499); respectively. The risk of bleeding was increased in patients receiving therapeutic anticoagulation compared to VTE prophylaxis (19.0% vs. 7.2%; adjusted odds ratio 2.729 [95% CI 1.074-9.935]; p=0.0349). One stroke occurred in the entire cohort in a patient receiving therapeutic anticoagulation.
Conclusion: Use of therapeutic anticoagulation in critically ill patients with pre-existing atrial fibrillation may increase bleeding rates compared to pharmacologic VTE prophylaxis.
Presenting Author
Maya Chilbert Pharm.D., BCCPUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences
Authors
Brian Kersten PharmD, BCPS, BCCCP
Buffalo General Medical Center
Lydia Lee BS, PharmD Candidate
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Lauren Gressel PharmD
Buffalo General Medical Center
Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Kimberly Zammit PharmD, BCPS, BCCP, FASHP
Mount Sinai