ABSTRACT
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an extremely serious and potentially fatal condition that can develop in patients taking heparin-based medications, such as unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). The incidence and risk factors for HIT in critically ill patients, however, are not well defined. METHODS: We retrospectively collected data on HIT test results, route of heparin administration, age, sex, heparin type (UFH or LMWH), and date of illness from patients admitted to the intensive care unit (ICU) and regular nursing floor (non-ICU) at our hospital between January 2011 and December 2014. We screened patients for HIT using the 4T score and confirmed the diagnosis through laboratory testing (direct enzyme immunoassay immunoglobulin G [IgG] or a platelet-activating antibody). RESULTS: We screened a total of 946 patients, 56 (5.9%) of whom were positive for HIT. Among 776 patients receiving UFH and 180 receiving LMWH, 2.8 and 6.6% developed HIT, respectively (P = 0.051). We then classified our patients into two groups: ICU, and non-ICU. In the non-ICU group (n = 317), 4 (2.7%) patients receiving LMWH and 25 (5.1%) receiving UFH were positive for HIT (P = 0.221). In the ICU group (n = 639), 1 (3.1%) patient receiving LMWH and 26 (9.1%) receiving UFH were positive for HIT (P = 0.249). The ICU group, therefore, had a higher cumulative incidence rate of HIT than the non-ICU group (8.5 vs. 4.5%). CONCLUSION: HIT was more common in ICU patients than non-ICU patients and in more patients receiving UFH than LMWH, although the differences were not statistically significant. Early diagnosis and appropriate treatment are essential to prevent adverse outcomes in patients with HIT.
ABSTRACT
OBJECTIVE: To assess the perception of the risk of stroke and the risks and benefits of oral anticoagulation (OAC) in patients with atrial fibrillation (AF). PATIENTS AND METHODS: Consecutive patients with chronic AF who presented for an outpatient cardiology visit or were admitted to a noncritical care cardiology ward service from September 15 through December 20, 2017, were invited to participate in this survey. Participants were asked to estimate their stroke risk without OAC and bleeding risk with OAC using a quantitative risk scale. The reported values were compared with subjectively estimated risks derived from the CHA2DS2-VASc and HAS-BLED scores. Similarly, we compared patient perception of the stroke risk reduction afforded with OAC compared with what is reported in the literature. RESULTS: A total of 227 patients were included in the analysis. The mean ± SD CHA2DS2-VASc score was 4.3±1.6, and HAS-BLED score was 2.3±1.2. Atrial fibrillation was paroxysmal in 53.3% and persistent/permanent in 46.7%. There was a negligible correlation between patient perceived and estimated risk of stroke (r=0.07; P=.32), and bleeding (r=0.16; P=.02). Most patients overestimated their risks of stroke and bleeding: 120 patients (52.9%) perceived an annual stroke risk greater than 20%, and 115 (53.5%) perceived an annual bleeding risk with OAC greater than 10%. Most patients (n=204; 89.9%) perceived that OAC would reduce their annual stroke risk by at least 50%. CONCLUSION: Perceived risks of stroke and bleeding are markedly overestimated in most patients with AF. Further research is needed to discern the root causes and to identify effective methods of bridging this alarming disparity.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Patients/psychology , Risk Assessment , Stroke/prevention & control , Administration, Oral , Aged , Cross-Sectional Studies , Female , Humans , Male , Surveys and QuestionnairesSubject(s)
Agriculture/standards , Colistin/administration & dosage , Colistin/supply & distribution , Drug Resistance, Bacterial , Gram-Negative Bacteria/drug effects , Agriculture/methods , Animals , Antimicrobial Stewardship , Gram-Negative Bacterial Infections/drug therapy , Humans , Lebanon , Livestock/microbiologyABSTRACT
OBJECTIVE: Hypocalcemia has been a common abnormality in the West, seen in patients admitted to the intensive care unit (ICU). It has also been linked with disease severity. We undertook this study to determine the frequency of hypocalcemia in patients admitted to the intensive care unit. MATERIALS AND METHODS: In a retrospective chart review from January 2004 till December 2004, patients admitted to our ICU were reviewed. Patients' age, sex, diagnosis, acute physiology and chronic health score APACHE II and ionized calcium were recorded. Patients were divided into three groups based on disease severity as measured by APACHE II. Hypocalcemia was defined as ionized Ca level less than 1.18 mmol/L. Frequency was determined in each group and correlation of hypocalcemia with disease severity was explored. RESULTS: Hypocalcemia was seen in 22.2% in group A (APACHE II < 10), 40.4% in group B (APACHE II 10-19) and 53.9% in group C (APACHE II > 19). Hypocalcemia and disease severity (APACHE II scores) were negatively correlated (P = 0.02). Mean ionized Ca levels in groups A, B and C were 1.22 mmol/L (+/-0.10), 1.19 mmol/L (+/-0.11) and 1.25 mmol/L (+/-0.24) respectively. CONCLUSIONS: Hypocalcemia is a common finding in critically ill patients. It is correlated with worsening disease severity. Mechanisms underlying hypocalcemia and the possible relationship of hypocalcemia with mortality need further consideration.
