NYMC Faculty Publications

Use of Therapeutic Hypothermia Among Patients with Coagulation Disorders - A Nationwide Analysis

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March 2018




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.