title: Factors affecting the severity of spontaneous retroperitoneal hemorrhage in anticoagulated patients.
abstract: BACKGROUND
  Clinical manifestations of spontaneous retroperitoneal hemorrhage (SRH) range from a small decrease in hemoglobin to hypotension requiring transfer to the intensive care unit (ICU). Our goal was to identify which anticoagulated patients are at increased risk for SRH and its complications.
  
  
  METHODS
  We conducted a retrospective review of 180 patients with SRH. Age, sex, presence of comorbidities, hemoglobin decrease, transfusion requirement, ICU stay, and length of ICU stay were recorded. Patients were divided into 5 groups based on their anticoagulants: (1) heparin and Coumadin, (2) heparin only, (3) Coumadin only, (4) heparin +/- Coumadin and aspirin (ASA) +/- Plavix, and (5) other anticoagulants.
  
  
  RESULTS
  Group 4 patients were more likely to require ICU admission and have longer ICU stay compared to others (P = .021 & P < or = 0.0001, respectively, by Kruskall-Wallis test). Patients with coronary artery disease were more likely to require ICU admission (P = .01 by chi-square test).
  
  
  CONCLUSIONS
  Patients on combined anticoagulant-antiplatelet therapy are more likely to require ICU admission and longer ICU stay. Close observation is warranted in these patients for early detection of SRH.
authors.affiliation: Department of Surgery, William Beaumont Hospital, Royal Oak, MI 48073, USA. rshah@beaumont.edu
authors.forename: Rachit D
authors.initials: RD
authors.lastname: Shah
authors.forename: Sapna
authors.initials: S
authors.lastname: Nagar
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Shanley
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Janczyk
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012187:Retroperitoneal Space; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors