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Comparison of blood coagulation factors between patients with gastrointestinal or intracranial bleeding under vitamin K antagonists

  • F. Moustafa
    Correspondence
    Corresponding author at: Emergency Unit, Gabriel Montpied Hospital, 58 Rue Montalembert, F-63003 Clermont-Ferrand cedex 1, France. Tel.: +33 4 73 75 19 99; fax: +33 4 73 75 15 53.
    Affiliations
    Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France
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  • J. Saint-Denis
    Affiliations
    Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France

    Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France
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  • S. Laporte
    Affiliations
    EA3065, Université Jean Monnet, Saint-Etienne, France

    Unité de Recherche Clinique, Innovation, et Pharmacologie, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France
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  • P. Mismetti
    Affiliations
    EA3065, Université Jean Monnet, Saint-Etienne, France

    Unité de Recherche Clinique, Innovation, et Pharmacologie, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France

    Service de Médecine interne et Thérapeutique, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France
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  • J. Schmidt
    Affiliations
    Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France

    Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France
    Search for articles by this author
      Vitamin K antagonists (VKAs) are the most commonly-used anticoagulant treatments for the prevention of thrombotic and embolic events related to atrial fibrillation, venous thromboembolism (VTE), and prosthetic heart valve. The incidence of major bleedings has been estimated at 7%, and that of fatal bleedings at 1% [
      • Linkins L.A.
      • Choi P.T.
      • Douketis J.D.
      Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis.
      ]. The primary bleeding complications observed in patients receiving long-term VKA therapy are either gastrointestinal (30–60% of cases) or cerebral (17–30%) [
      • Palareti G.
      • Leali N.
      • Coccheri S.
      • et al.
      Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian study on complications of oral anticoagulant therapy.
      ,
      • Go A.S.
      • Hylek E.M.
      • Chang Y.
      • Phillips K.A.
      • et al.
      Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice?.
      ]. The current guidelines recommend administering four-factor PCC (4 F-PCC) rather than FFP to reverse VKA-induced coagulopathy in patients suffering from major VKA-associated bleedings, while optimal dosage protocols have not yet been clearly defined, thus differing widely [
      • Keeling D.
      • Baglin T.
      • Tait C.
      • et al.
      British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin — fourth edition.
      ,
      • Holbrook A.
      • Schulman S.
      • Witt D.M.
      • et al.
      American College of Chest Physicians. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines.
      ,
      • Pernod G.
      • Godier A.
      • Gozalo C.
      • et al.
      French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding).
      ,
      • Khorsand N.
      • Kooistra H.A.
      • van Hest R.M.
      • et al.
      A systematic review of prothrombin complex concentrate dosing strategies to reverse vitamin K antagonist therapy.
      ]. The effect of VKA treatment on procoagulant factor levels is well-known, causing a decrease in FII, FVII, FIX, FX, and proteins C and S, yet no decrease in fibrinogen, FV, FVIII, FXI, or in antithrombin. However, only a few studies have investigated blood coagulation factors in bleeding events under VKAs, and a clearer understanding of the coagulation factor losses specific to each bleeding type would enable us to optimize currently-recommended treatments by adapting them to bleeding type and lost blood volume. With this study, we sought to compare the levels of blood coagulation factors in patients receiving VKAs and exhibiting serious gastrointestinal or intracranial bleeding.

      Keywords

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