• David R Williamson, Martin Albert, Diane Heels-Ansdell, Donald M Arnold, François Lauzier, Ryan Zarychanski, Mark Crowther, Theodore E Warkentin, Peter Dodek, John Cade, Olivier Lesur, Wendy Lim, Robert Fowler, Francois Lamontagne, Stephan Langevin, Andreas Freitag, John Muscedere, Jan O Friedrich, William Geerts, Lisa Burry, Jamal Alhashemi, Deborah Cook, and PROTECT collaborators, the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
• Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada; Department of Pharmacy, Université de Montréal, Montreal, QC, Canada. Electronic address: david.williamson@umontreal.ca.
• Chest. 2013 Oct 1; 144 (4): 1207-1215.

BackgroundThrombocytopenia is the most common hemostatic disorder in critically ill patients. The objective of this study was to describe the incidence, risk factors, and outcomes of thrombocytopenia in patients admitted to medical-surgical ICUs.MethodsThree thousand seven hundred forty-six patients in 67 centers were enrolled in a randomized trial in which unfractionated heparin was compared with low-molecular-weight heparin (LMWH) for thromboprophylaxis. Patients who had baseline platelet counts < 75 × 10(9)/L or severe coagulopathy at screening were excluded. We analyzed the risk of developing mild (100-149 × 10(9)/L), moderate (50-99 × 10(9)/L), and severe (< 50 × 109/L) thrombocytopenia during an ICU stay. We also assessed independent and time-varying predictors of thrombocytopenia and the effect of thrombocytopenia on major bleeding, transfusions, and death.ResultsThe incidences of mild, moderate, and severe thrombocytopenia were 15.3%, 5.1%, and 1.6%, respectively. The predictors of each category of thrombocytopenia were APACHE (Acute Physiology and Chronic Health Evaluation) II score, use of inotropes or vasopressors, and renal replacement therapy. The risk of moderate thrombocytopenia was lower in patients who received LMWH thromboprophylaxis but higher in surgical patients and in patients who had liver disease. Each category of thrombocytopenia was associated with subsequent bleeding and transfusions. Moderate and severe thrombocytopenia were associated with increased ICU and hospital mortality.ConclusionA high severity of illness, prior surgery, use of inotropes or vasopressors, renal replacement therapy, and liver dysfunction are associated with a higher risk of thrombocytopenia developing in the ICU, whereas LMWH thromboprophylaxis is associated with a lower risk. Patients who develop thrombocytopenia in the ICU are more likely to bleed, receive transfusions, and die.

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