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Use of therapeutic hypothermia among patients with coagulation disorders - A Nationwide analysis
Mahek Shah1, Kaushal Parikh2, Brijesh Patel1
1Department of Cardiology, Lehigh Valley Hospital Network, Allentown, PA, United States.
Insights
Therapeutic hypothermia (TH) increases bleeding and transfusion needs in patients with coagulation disorders (CD). However, TH does not impact in-hospital mortality for these patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Cardiovascular Research
Background:
- Therapeutic hypothermia (TH) impacts coagulation factors and platelets, potentially increasing bleeding risk.
- The effect of TH on patients with pre-existing coagulation disorders (CD) is not well understood.
- Understanding TH's impact on CD patients is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the effect of therapeutic hypothermia (TH) on bleeding complications.
- To assess the impact of TH on in-hospital mortality in patients with coagulation disorders (CD).
- To compare outcomes between patients with and without CD undergoing TH.
Main Methods:
- Retrospective analysis of 6469 TH cases from the National Inpatient Sample (2009-2014).
- Identified 1036 patients (16.02%) with coagulation disorders (CD).
- Used propensity score matching to compare bleeding events, blood product transfusion, and mortality between patients with and without CD.
Main Results:
- Patients with CD had significantly higher rates of bleeding events (13% vs. 8.5%) and blood product transfusion (25.0% vs. 14.1%) compared to those without CD.
- No significant difference was observed in intracranial bleeding or hemorrhagic stroke rates between the groups.
- In-hospital mortality rates were similar for patients with and without CD (74.5% vs. 74.8%).
Conclusions:
- Therapeutic hypothermia in patients with coagulation disorders is associated with increased bleeding and transfusion requirements.
- Despite increased bleeding risks, therapeutic hypothermia does not appear to affect in-hospital mortality in patients with coagulation disorders.
- Further research may explore strategies to mitigate bleeding risks in this patient population.
Objectives:
The study aimed to assess the impact of therapeutic hypothermia (TH) on bleeding and in-hospital mortality among patients with coagulation disorders (CD).
Background:
TH affects coagulation factors and platelets putting patients at risk for bleeding and worse outcomes. Effect of TH among patients with CD remains understudied.
Methods:
Between 2009 and 2014, a total of 6469 cases of TH were identified using the National Inpatient Sample out of which 1036 (16.02%) had a CD. The incidence of bleeding events, blood product transfusion and in-hospital mortality was compared between patients with and without CD using one to one propensity score matching.
Results:
Proportion of patients with CD increased during study duration from 13.0% to 17.4% from 2009 to 2014. Propensity matching was performed to adjust for baseline differences with 799 patients in both groups depending on presence or absence of CD. Patients with CD had a higher rate of bleeding events (13% vs. 8.5%; adjusted odds ratio 1.60; 95% confidence interval 1.16-2.23; P = 0.004), and blood product transfusion (25.0% vs. 14.1%; aOR 2.03; 95% CI 1.56-2.63; p < 0.001) compared to those without CD. There was no difference in rate of intracranial bleeding or hemorrhagic strokes between those with and without CD (3.3% vs. 3.2%; p = 0.88). There was no difference in mortality between patients with CD and those without (74.5% vs. 74.8%, aOR 0.98, 95% CI 0.78-1.23; P = 0.86).
Conclusions:
Use of TH with CD resulted in more bleeding events and blood product transfusion but there was no difference in hospital mortality.
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