Emergency admissions for major haemorrhage associated with antithrombotics: A cohort studyReportar como inadecuado

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1 Service d-accueil et de traitement des urgences 2 CIC-IT Rennes 3 Service de Pharmacologie

Abstract : Introduction: to describe antithrombotic-related major haemorrhage, therapeutic management and outcomes in patients admitted to an emergency department of a teaching hospital.Material and method: This prospective cohort included patients older than 16 years with antithrombotic-related major haemorrhage identified by monthly diagnostic codes computerised requests. Major haemorrhage was defined by at least one the following criteria: unstable hemodynamic, haemorrhagic shock, uncontrollable bleeding, need for transfusion or haemostatic procedure, or a life threatening location.Results: between January 1, 2011 and December 31, 2012, 913 patients met the inclusion criteria 1.2 patients per day, median age 82. Oral anticoagulants alone or in combination were used by 429 patients, antiplatelet agents alone or dual therapy by 420 patients, and parenteral anticoagulants by 64 patients. Major haemorrhages were: gastrointestinal bleeding 37.5%, intracranial haemorrhage 34.4%, muscular hematoma 9.4%, external haemorrhage 16.9% and internal haemorrhage 1.9%. At 1 month, 179 patients 19.8% died, mostly patients with intracranial haemorrhage 64.2%. Prognostic factors for death were age and Glasgow coma scale at admission for intracranial haemorrhage, age and mean arterial pressure at admission for other major haemorrhages. Oral anticoagulant therapy was a predictor for death in intracranial haemorrhages. Reversal therapy was initiated in only 50.5% of patients with vitamin K antagonists, without effect on the mortality rate.Conclusion: This study shows the magnitude and the severity of antithrombotic-related major haemorrhage. The high mortality rate supports careful awareness in individual risk benefit assessment, especially for elderly.

Keywords : emergency department antiplatelet anticoagulant antithrombotic major bleeding intracranial haemorrhage

Autor: Jacques Bouget - Emmanuel Oger - Nathalie Nicolas -

Fuente: https://hal.archives-ouvertes.fr/


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