Use of Therapeutic Hypothermia Among Patients with Coagulation Disorders - A Nationwide Analysis
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.
Shah, M., Parikh, K., Patel, B., Agarwal, M., Garg, L., Agrawal, S., Arora, S., Patel, N., Patel, N., & Frishman, W. (2018). Use of Therapeutic Hypothermia Among Patients with Coagulation Disorders - A Nationwide Analysis. Resuscitation, 124, 35-42. https://doi.org/10.1016/j.resuscitation.2018.01.005