PURPOSE:The postoperative bleeding complications associated with tracheostomies are reported to be between 0% and 33%. The purpose of this study was to examine the effect of full anticoagulation with heparin on the incidence of non-significant and significant bleeding in patients following tracheostomies.
METHODS:A 4.5 year retrospective analysis of the Cooper University Hospital Project Impact Database (Cerner). Adult patients admitted to the medical/surgical critical care service between October 2002 and March 2007 with a tracheostomy performed during their ICU stay were included. Data abstracted included bleeding from tracheostomy site, full anticoagulation with heparin and APACHE II score. Significant bleeding for this study was defined as the need for transfusion due to blood loss from the tracheostomy site. Mann Whitney U test and Fisher exact test were used to compare groups.
RESULTS:6,518 admissions to the ICU, 579(8.9%) had a tracheostomy performed. Seventeen patients had a bleeding complication, with 7 requiring transfusion. Five out of 7 transfused patients were receiving continuous IV heparin. There was no APACHE II difference between the two groups compared. One hundred and forty patients (24.9%) were fully anticoagulated with heparin in the non bleeding group (n=562) compared to 7 (41.1%) in the bleeding group (n=17). Statistically, patients receiving anticoagulation were not more likely to bleed, OR 2.1(0.85–5.46) p=.156. An association between full anticoagulation with heparin and significant bleeding was identified in this study, OR 7.7 (95%CI 1.7–34.8) p=0.012.
CONCLUSION:Our results show that full anticoagulation with heparin does not statistically predispose patients to bleeding. However, when bleeding occurs full anticoagulation with heparin is associated with significant bleeding. The limitations of this study include its retrospective design, the hetereogeneity of surgical technique and a non-uniform patient population who may have had other risk factors for bleeding.
CLINICAL IMPLICATIONS:Decisions for full heparin anticoagulation in patients with tracheostomies need to be made in light of significant bleeding risk.
DISCLOSURE:Nitin Puri, No Financial Disclosure Information; No Product/Research Disclosure Information