Factors Associated with Adverse Outcome in Elderly Patients Managed with Anticoagulants in Intensive Care Unit

Muhammad Ali; Rubab Ahmed; Andaleeb Khan; Sohail Zafar; Muhammad Ahmad; Syed Fayyaz Mehmood

doi:10.51253/pafmj.v76i3.10900

Authors

Muhammad Ali Department of Medicine, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
Rubab Ahmed Department of Medicine, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
Andaleeb Khan Department of Medicine, LT FTC Lipa Pakistan
Sohail Zafar Department of Medicine, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
Muhammad Ahmad Department of Medicine, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
Syed Fayyaz Mehmood Department of Medicine, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i3.10900

Keywords:

Anticoagulation; Glasgow Coma Scale; Intensive care unit

Abstract

Objective: To look for the factors associated with adverse outcome in elderly patients managed with anticoagulants in intensive care units of a military hospital of Baluchistan.

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Critical Care Medicine, Combined Military Hospital Quetta, Pakistan from Jan 2022 to Mar 2023.

Methodology: Patients more than 60 years of age admitted in medical and surgical intensive care units of our hospital and managed with anticoagulants were included. They underwent detailed evaluation at the time of admission in respective critical care unit and then followed up for two weeks to look for immediate outcome. Major bleed during the ICU stay, length of stay more than 2 weeks or death were taken as parameters of adverse outcome. Relevant clinical factors were associated with poor outcome in our study participants.

Results: Out of 48 elderly patients admitted in intensive care unit and managed with anticoagulation, 31(64.5%) had poor outcome while 17(35.5%) had good outcome. Mean age of the study participants was 65.21 ±2.16 years. GCS score <3 at the time of presentation and presence of acidosis at the time of presentation were the factors associated with adverse outcome (p-value>0.05) in elderly patients recruited in our study.

Conclusion: Adverse outcome was seen in considerable number of elderly patients admitted in medical or surgical intensive care unit and managed with anticoagulants. Acidosis at time of presentation and GCS score <13 at time of presentation were the factors associated with poor outcome in our study participants.

Downloads

Download data is not yet available.

References

1. De Matteis G, Burzo ML, Della Polla DA, Serra A, Russo A, Landi F, et al. Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia. J Clin Med 2022; 12(1): 59.

http://doi.org/10.3390/jcm12010059

2. Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev 2023 ; 84(1): 101832.

http://doi.org/10.1016/j.arr.2022.101832

3. Asaduzzaman M, Nazmul-Alam ZHM, Zabed-Jillul Bari M, Jahangir Alam MM, Ranjan Chakraborty S, Ferdousi T et al. Clinical Characteristics and Predictors of Mortality in Elderly Patients Hospitalized with COVID-19 in Bangladesh: A Multicenter, Retrospective Study. Interdiscip Perspect Infect Dis 2022; 2022: 5904332. http://doi.org/10.1155/2022/5904332

4. Shevell L, Ochs M, Schaefer J. Prophylactic Anticoagulation in Patients with Cancer: When and How?. Curr Oncol Rep 2023; 2(3): 201–209. https://doi.org/10.1007/s11912-023-01358-9

5. Ramli NN, Iberahim S, Mohd Noor NH, Zulkafli Z, Shihabuddin TM, Din MH, et al. Haemostasis and Inflammatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma-Immobilized Patients. Diagnostics 2023; 13(1): 150.

http://doi.org/10.3390/diagnostics13010150

6. Kyriakoulis KG, Dimakakos E, Kyriakoulis IG, Catalano M, Spyropoulos AC, Schulman S, et al. Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials. J Clin Med 2022; 11(20): 5997.

http://doi.org/ 10.3390/jcm11205997

7. Gross PL, Chan NC. Thromboembolism in Older Adults. Front Med 2021; 7:470016.

http://doi.org/10.3389/fmed.2020.470016

8. Launey Y, Coquet A, Lasocki S, Dahyot-Fizelier C, Huet O, Le Pabic E, et al. Factors associated with an unfavourable outcome in elderly intensive care traumatic brain injury patients. a retrospective multicentre study. BMC Geriatr 2022; 22(1):1004.

http://doi.org/10.1186/s12877-022-03651-x

9. Ejaz A, Ahmed MM, Tasleem A, Niazi MRK, Ahsraf MF, Ahmad I, et al. Thromboprophylaxis in Intensive Care Unit Patients: A Literature Review. Cureus 2018; 10(9): e3341.

http://doi.org/10.7759/cureus.3341

10. Parikh K. Venous thromboembolism prophylaxis in medical ICU patients in Asia (VOICE Asia): A multicenter, observational, cross-sectional study. Thromb Res 2012; 129(4): 152-158.

11. Lankoandé M, Bonkoungou P, Simporé A, SOmda G, Kabore RAF. Inhospital outcome of elderly patients in an intensive care unit in a Sub-Saharan hospital. BMC Anesthesiol 2018; 18(3): 118-123. https://doi.org/10.1186/s12871-018-0581-x

12. Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med 2020; 9(8): 2467.

http://doi.org/10.3390/jcm9082467

13. Fleuren LM, Tonutti M, de Bruin DP, Lalisang RCA, Dam TA, Gommers D, et al. Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients: a multicenter machine learning study with highly granular data from the Dutch Data Warehouse. Intensive Care Med Exp 2021; 9(1): 32.

http://doi.org/10.1186/s40635-021-00397-5

14. Yagi K, Fujii T. Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy. Crit Care 2021; 25(1): 314.

http://doi.org/10.1186/s13054-021-03677-4

15. Korayem GB, Alshaya OA, Alsubaie NS, Alabdulkarim DA, Almohammed OA, Alfayez OM, et al. Safety and effectiveness of thromboprophylaxis use in hospitalized elderly medical patients at a Saudi tertiary care center. Saudi Pharm J 2021; 29(5): 456-46. http://doi.org/10.1016/j.jsps.2021.04.008

16. Mishra AK, Sahu KK, Lal A, George SV. Factors contributing to poor outcome in patients on warfarin receiving 4-factor prothrombin complex concentrate in critically ill. Acta Biomed 2021; 92(5): e2021281.

http://doi.org/10.23750/abm.v92i5.9601

17. Holbrook A, Benipal H, Paterson JM, Martins D, Greaves S, Lee M, et al. Adverse event rates associated with oral anticoagulant treatment early versus later after hospital discharge in older adults: a retrospective population-based cohort study. CMAJ Open 2021; 9(2): E364-E375.

http://doi.org/10.9778/cmajo.20200138

18. Dagar S, Emektar E, Uzunosmanoglu H, Cevik Y. Assessment of factors affecting mortality in geriatric patients with warfarin overdose. Turk J Emerg Med 2020; 20(4): 180-185.

http://doi.org/10.4103/2452-2473.297463