Venous and arterial thromboembolism in severe sepsis

Robert L. Levine; Jacques R. LeClerc; Joan E. Bailey; Matthew J. Monberg; Samiha Sarwat

doi:10.1160/TH08-01-0004

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2008; 99(05): 892-898
DOI: 10.1160/TH08-01-0004

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Venous and arterial thromboembolism in severe sepsis

Robert L. Levine

¹Department of Neurosurgery, University of Texas School of Medicine at Houston, Houston, Texas, USA

,

Jacques R. LeClerc

²Retired employee and current shareholder/beneficiary of Eli Lilly & Co., 2404 Sunny Slope, Bridgewater, New Jersey, USA

,

Joan E. Bailey

³Eli Lilly and Company, Lilly Corporate Center, Drop Code 6072, Indianapolis, Indiana, USA

,

Matthew J. Monberg

⁴Eli Lilly and Company, Drop Code 6831, Indianapolis, Indiana, USA

,

Samiha Sarwat

⁵Eli Lilly and Company, Lilly Corporate Center, Drop Code 6025, Indianapolis, Indiana, USA

› Institutsangaben

Abstract

Summary

The burden of thromboembolism (TE) in severe sepsis is largely unknown. We assessed the prevalence of venous and arterial TE in patients with severe sepsis over a four-week period. We performed a retrospective analysis of a pooled database of three randomized, placebo-controlled trials of two novel pharmacological agents for the treatment of severe sepsis, drotrecogin alfa (activated) (DrotAA)and secretory phospholipase A2 inhibitor (sPLA₂I). The study was conducted at intensive care units of the participating institutions. A total of 2,649 patients with known or suspected infection and sepsis-associated acute organ dysfunction were enrolled in the three trials and were assigned to treatment groups (DrotAA=850; sPLA₂I =578; placebo=1221). The database was queried for venous and arterial TE, using investigator reports of serious adverse events. Eighty-four of 2,649 patients (3.2%; 95% confidence interval, 2.5% to 3.9%) developed at least one thromboembolic event over 28 days. Nearly threequarters of episodes were atheroembolic (n=62); 25% involved the deep venous system (n=25). Ischemic stroke (n=30) and venous thromboembolism (n=25) each occurred in about 1% of patients. Ischemic stroke and acute coronary syndrome had a higher peak incidence during the first five days compared to venous TE onset, which was more constant over the 28-day period. Subgroup analysis by pooled treatment groups yielded TE rates of 2.0% (DrotAA), 3.5% (placebo), and 4.0% (sPLA₂I), respectively. Clinically manifest TE occurred in about 3% of severe sepsis patients treated in the intensive care unit over a 28-day period. Arterial TE may be more common than previously recognized. More accurate estimates of TE prevalence and relationship to sepsis await future studies.

Keywords

Sepsis - thromboembolism - stroke - venous thrombosis - pulmonary embolism - drotrecogin alfa (activated)

Volltext

Referenzen

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