Highlights
- •Real-life study with 544 patients hospitalized for major bleeding while on VKAs1Vitamin K antagonistse
- •
- •The risk for death at 30 days was substantial (about 20%).
- •Age over 85 years, low GCS score and shock were associated with death at 30 days.
- •Higher incidence of ischemic stroke and of acute coronary syndrome.
Abstract
Background
The optimal management of major bleeding associated with vitamin K antagonists remains
unclear.
Objectives
The aim of the study was to assess the determinants of outcome of vitamin K antagonists-associated
major bleeding and the outcome of bleeding in relation with the therapeutic management.
Methods
Patients hospitalized for major bleeding while on vitamin K antagonists were included
in a prospective, cohort study. Major bleeding was defined according to the criteria
of the International Society of Thrombosis Haemostasis. The primary study outcome
was death at 30 days from major bleeding.
Results
544 patients were included in this study, of which 282 with intracranial hemorrhage.
Prothrombin complex concentrates were used in 51% and in 23% of patients with intracranial
hemorrhage or non-intracranial major bleeding, respectively (p < 0.001); fresh frozen plasma was used in 7% and in 17% of patients with intracranial
hemorrhage or non-intracranial major bleeding (p < 0.001).
Death at 30 days occurred in 100 patients (18%), 72 patients with intracranial hemorrhage and
28 patients with non-intracranial major bleeding. Age over 85 years, low Glasgow Coma Scale score and shock were independent predictors of death
at 30 days. Invasive procedures were associated with decreased risk of death.
Conclusions
Among the patients hospitalized for major bleeding while on vitamin K antagonists,
the risk for death is substantial. The risk for death is associated with the clinical
severity of major bleeding as assessed by the GCS score and by the presence of shock
more than with the initial localization of major bleeding (ICH vs other sites).
Keywords
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Article info
Publication history
Published online: June 09, 2016
Accepted:
May 17,
2016
Received in revised form:
May 11,
2016
Received:
January 27,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
