Key result
Therapeutic anticoagulation linked to ~170% higher bleeding risk vs prophylaxis in critically ill AF patients.
Why the study?
Determining the optimal anticoagulation regimen for AF in critically ill patients is challenging because these patients face increased risks of both bleeding and clotting.
Does therapeutic anticoagulation increase bleeding or prevent thromboembolic events compared to venous thromboembolism prophylaxis in critically ill adults with pre-existing atrial fibrillation?
Observational (n=199)
Does therapeutic anticoagulation increase bleeding or prevent thromboembolic events compared to venous thromboembolism prophylaxis in critically ill adults with pre-existing atrial fibrillation?
In critically ill patients with pre-existing atrial fibrillation, therapeutic anticoagulation significantly increases bleeding risk without a clear reduction in stroke compared to standard VTE prophylaxis.
Answers are grounded in this paper and cite their sources.
Associated with increased bleeding without stroke reduction in critically ill AF; leaves open optimal strategy versus prophylaxis.
Purpose: The optimal anticoagulation regimen for atrial fibrillation (AF) in critically ill patients is challenging as these patients may be at an increased risk for bleeding and clotting despite an absence or presence of anticoagulation. The purpose of this study was to compare bleeding and thrombotic rates in critically-ill adults with pre-existing AF receiving therapeutic anticoagulation versus chemical or mechanical venous thromboembolism prophylaxis. Methods: A retrospective, observational study was conducted. The primary outcome identified rate of International Society of Thrombosis and Hemostasis bleeding, and secondarily assessed all venous or arterial thromboembolic events. To determine risk-factors associated with bleeding and to account for differences in baseline characteristics, a multivariable logistic regression model was used. Results: A total of 199 patients were included, 100 receiving therapeutic anticoagulation and 99 receiving venous thromboembolism prophylaxis. Patients receiving therapeutic anticoagulation compared to chemical or mechanical prophylaxis had a median (IQR) CHA 2 DS 2 VASc score of 4 (3-5) versus 4 (2-5) ( P = .5499) and HAS-BLED score of 3 (3-4) versus 3 (2-4) ( P = .0013); respectively. There was almost a threefold adjusted increased risk of bleeding in patients receiving therapeutic anticoagulation compared to venous thromboembolism prophylaxis (adjusted odds ratio [aOR] 2.7 [95% CI 1.1-9.9]; P = .0349). One stroke occurred in a patient receiving therapeutic anticoagulation, and none occurred in patients in the prophylaxis group ( P = 1.000). Conclusion: Use of therapeutic anticoagulation in critically ill patients with pre-existing AF may increase bleed rates without protecting against stroke development.
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Chilbert et al. (2024) conducted an observational in Critically ill adults with pre-existing atrial fibrillation (n=199). Therapeutic anticoagulation vs. Chemical or mechanical venous thromboembolism prophylaxis was evaluated on Rate of International Society of Thrombosis and Hemostasis bleeding (aOR 2.7, 95% CI 1.1-9.9, p=.0349). Therapeutic anticoagulation in critically ill patients with pre-existing AF was associated with an increased risk of bleeding compared to prophylaxis (aOR 2.7; 95% CI 1.1-9.9; P=0.0349).
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