Institutional Variations in the Treatment Intensity of Anticoagulant Therapy for Patients with Sepsis-Induced Disseminated Intravascular Coagulation and Outcomes: A Multicenter Cohort Study

2018 ◽  
Author(s):  
Daisuke Kudo ◽  
Mineji Hayakawa ◽  
Hiroaki Iijima ◽  
Kazuma Yamakawa ◽  
Shinjiro Saito ◽  
...  
Keyword(s):  
Cohort Study ◽  
Anticoagulant Therapy ◽  
Disseminated Intravascular Coagulation ◽  
Treatment Intensity ◽  
Multicenter Cohort Study ◽  
Intravascular Coagulation ◽  
Multicenter Cohort

scholarly journals The Treatment Intensity of Anticoagulant Therapy for Patients With Sepsis-Induced Disseminated Intravascular Coagulation and Outcomes: A Multicenter Cohort Study

2019 ◽  
Vol 25 ◽  
pp. 107602961983915
Author(s):  
Daisuke Kudo ◽  
Mineji Hayakawa ◽  
Hiroaki Iijima ◽  
Kazuma Yamakawa ◽  
Shinjiro Saito ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Anticoagulant Therapy ◽  
Disseminated Intravascular Coagulation ◽  
High Intensity ◽  
Anticoagulation Therapy ◽  
Multicenter Cohort Study ◽  
Intravascular Coagulation ◽  
Low Intensity ◽  
Number Of Patients

We examined the institutional variations in anticoagulation therapy for sepsis-induced disseminated intravascular coagulation (DIC) and their effects on patient outcomes. This post hoc analysis of a cohort study included 3195 patients with severe sepsis across 42 intensive care units. To evaluate differences in the intensity of anticoagulation therapy, the proportion of patients receiving anticoagulation therapy and the total number of patients with sepsis-induced DIC were compared. Predicted in-hospital mortality for each patient was calculated using logistic regression analysis. To evaluate survival outcomes, the actual/mean predicted in-hospital mortality ratio in each institution was calculated. Thirty-eight institutions with 2897 patients were included. Twenty-five institutions treated 60% to 100% (high-intensity institutions), while the rest treated 0% to 50% (low-intensity institutions) of patients with sepsis-induced DIC having anticoagulant therapy. Every 10-unit increase in the intensity of anticoagulant therapy was associated with lower in-hospital mortality (odds ratio: 0.904). A higher number of high-intensity institutions (compared to low-intensity institutions) had lower in-hospital mortality and fewer bleeding events than predicted. In conclusion, institutional variations existed in the use of anticoagulation therapy in patients with sepsis-induced DIC. High-intensity anticoagulation therapy was associated with better outcomes.

Early Discern COVID-19 from the Suspected Patients via Fever Clinics: A Multicenter Cohort Study from Shanghai

2020 ◽  
Author(s):  
Bei Mao ◽  
Yang Liu ◽  
Yan-hua Chai ◽  
Xiao-yan Jin ◽  
Hai Wen Luo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study

2021 ◽  
pp. 1-7
Author(s):  
Walusa Assad Gonçalves-Ferri ◽  
Francisco Eulógio Martinez ◽  
Fábia Pereira Martins-Celini ◽  
João Henrique Carvalho Leme de Almeida ◽  
Renato Procianoy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

scholarly journals Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Richard Descamps ◽  
Mouhamed D. Moussa ◽  
Emmanuel Besnier ◽  
Marc-Olivier Fischer ◽  
Sébastien Preau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Univariate Analysis ◽  
Hemorrhagic Complication ◽  
Multicenter Cohort Study ◽  
Membrane Oxygenation ◽  
Multicenter Cohort ◽  
Hemorrhagic Event ◽  
Hemorrhagic Events ◽  
Va Ecmo

Abstract Background Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. Methods We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Results Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). Conclusion In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

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