Prevalence, management, and outcomes of critically ill patients with prothrombin time prolongation in United Kingdom intensive care units.

Critical Care Medicine
T S WalshWriting Committee of the Intensive Care Study of Coagulopathy Investigators

Abstract

Coagulopathy occurs frequently in critically ill patients, but its epidemiology, current treatment, and relation to patient outcome are poorly understood. We described the prevalence, risk factors, and treatment of prolongation of the prothrombin time in critically ill patients using the international normalized ratio to standardize data and explored its association with intensive care unit survival. Prospective multiple center observational cohort study. Twenty-nine adult intensive care units in the United Kingdom. All sequentially admitted patients over an 8-wk period. None. Prospective daily data were collected concerning prevalence, predefined risk factors, and treatment of coagulopathy throughout intensive care unit admission. Of 1923 intensive care unit admissions, 30% developed abnormal international normalized ratio values (defined as an international normalized ratio > 1.5). Most international normalized ratio abnormalities were minor and short-lived (73% of worst international normalized ratio values 1.6-2.5). Male sex, chronic liver disease, sepsis, warfarin therapy, increments in Acute Physiology and Chronic Health Evaluation II score, severity of renal and hepatic dysfunction, and red cell transfusions were all ind...Continue Reading

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