Table 12.

—Prognostic Factors Associated With Bleeding in ICU Patients

Study/Year	Type of Study	Participants	Intervention	Outcomes	Follow-up	Results	Comments
Cook et al70/2008 (DIRECT)	Multicenter prospective cohort	138 Medical-surgical ICU patients with renal insufficiency	Dalteparin 5,000 International Units SC daily	Daily bedside clinical assessment using ICU bleeding tool	Up to 30 d	Increased INR HR for 0.5-unit difference, 1.68 (95% CI, 1.07-2.66)	Independent variables: baseline characteristics,a type of dialysis, INR, aPTT, platelet count, and within preceding 3 d: therapeutic heparin treatment, prophylactic dalteparin, detectable trough anti-Xa level, any dose of aspirin
Arnold et al68/2007	Single-center prospective cohort	100 Consecutive medical-surgical ICU patients	None. Daily bleeding assessment done in duplicate by blinded, trained assessors	Fatal bleeding: bleeding causing death. Major bleeding: bleeding causing severe physiologic derangements, occurred at a critical site, or required therapeutic intervention. Minor bleeding: bleeding not meeting criteria for major bleeding	During ICU stay until discharge, death, or 90 d	Most major bleeding events were GI; 90% of patients experienced 480 bleeding events; 94.8% minor and 5.2% major. HRs (95% CI) for predictors of major bleeding: prolonged aPTT 1.2 (1.1-1.3) for every 10 s increase, decrease in platelet count 1.7 (1.2-2.3) for every 50 × 109/L decrease	Risk factors included in the model: admission diagnosis, APACHE II score, platelet count, coagulation parameters, use of prophylactic or therapeutic doses of UFH or LMWH, use of antiplatelet agents, need for dialysis

APACHE = Acute Physiologic and Chronic Health Evaluation; aPTT = activated partial thromboplastin time; INR = international normalized ratio; SC = subcutaneous. See Table 1-4 legends for expansion of abbreviations.

^aAge, APACHE II score, surgical vs medical admission, pre-ICU renal status.