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Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study

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Abstract

Purpose

The aim of this study was to describe the incidence of venous thromboembolism (VTE) and major bleeding among hospitalized patients with hematologic malignancy, assessing its association with critical illness and other baseline characteristics.

Methods

We conducted a population-based cohort study of hospitalized adults with a new diagnosis of hematologic malignancy in Ontario, Canada, between 2006 and 2017. The primary outcome was VTE (pulmonary embolism or deep venous thrombosis). Secondary outcomes were major bleeding and in-hospital mortality. We compared the incidence of VTE between intensive care unit (ICU) and non-ICU patients and described the association of other baseline characteristics and VTE.

Results

Among 76,803 eligible patients (mean age 67 years [standard deviation, SD, 15]), 20,524 had at least one ICU admission. The incidence of VTE was 3.7% in ICU patients compared to 1.2% in non-ICU patients (odds ratio [OR] 3.08; 95% confidence interval [CI] 2.77–3.42). The incidence of major bleeding was 7.6% and 2.4% (OR 3.33; 95% CI 3.09–3.58), respectively. The association of critical illness and VTE remained significant after adjusting for potential confounders (OR 2.92; 95% CI 2.62–3.25). We observed a higher incidence of VTE among specific subtypes of hematologic malignancy and patients with prior VTE (OR 6.64; 95% CI 5.42–8.14). Admission more than 1 year after diagnosis of hematologic malignancy (OR 0.64; 95% CI 0.56–0.74) and platelet count ≤ 50 × 109/L at the time of hospitalization (OR 0.63; 95% CI 0.48–0.84) were associated with a lower incidence of VTE.

Conclusion

Among patients with hematologic malignancy, critical illness and certain baseline characteristics were associated with a higher incidence of VTE.

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Data availability

The study was conducted using relevant provincial administrative databases available at ICES in Toronto, Canada. This data is not publicly available and only researchers with ICES credentials can access this data.

Code availability

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by Cancer Care Ontario (CCO). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The authors would also like to thank Fernando Binder for his help with Fig. 2.

Funding

This project was awarded the “Department of Medicine Research Fund Voucher Program Award 2021–2022” from Sinai Health, Toronto, for an amount of 5000 CAD.

Author information

Author notes

  1. Sangeeta Mehta and Bruno L. Ferreyro contributed equally and are joint senior authors of this manuscript.

Authors and Affiliations

  1. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Federico C. Carini, Federico Angriman, Damon C. Scales, Laveena Munshi, Lisa D. Burry, Sangeeta Mehta & Bruno L. Ferreyro

  2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Federico Angriman & Bruno L. Ferreyro

  3. Department of Medicine, University Health Network, Toronto, ON, Canada

    Federico C. Carini

  4. Department of Medicine, Sinai Health System, Toronto, ON, Canada

    Federico C. Carini, Laveena Munshi, Lisa D. Burry, Sangeeta Mehta & Bruno L. Ferreyro

  5. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Federico Angriman & Damon C. Scales

  6. ICES (Institute for Clinical Evaluative Sciences), Toronto, ON, Canada

    Damon C. Scales

  7. Department of Pharmacy, Sinai Health System, Toronto, ON, Canada

    Lisa D. Burry

  8. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Lisa D. Burry

  9. Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Hassan Sibai

  10. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Hassan Sibai

  11. Mount Sinai Hospital, 600 University Avenue, Suite 5-292, Toronto, ON, M5G 1X5, Canada

    Federico C. Carini

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  1. Federico C. Carini
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Consortia

the SELECTION study group

Contributions

BLF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: FCC, FA, BLF, DCS, SM, LM. Acquisition, analysis, and interpretation of data: all authors. Drafting of the manuscript: FCC, FA and BLF. Critical revision of the manuscript for important intellectual content and approval of the final draft: all authors. Statistical analysis: BLF, FA.

Corresponding author

Correspondence to Federico C. Carini.

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The authors have no relevant financial or non-financial interests to disclose.

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ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement. The use of the data in this project is authorized under section 45 of Ontario’s Personal Health Information Protection Act (PHIPA) and does not require review by a Research Ethics Board.

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Carini, F.C., Angriman, F., Scales, D.C. et al. Venous thromboembolism in critically ill adult patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 50, 222–233 (2024). https://doi.org/10.1007/s00134-023-07287-2

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