Factors affecting the severity of spontaneous retroperitoneal hemorrhage in anticoagulated patients.
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.
Shah
Rachit D
RD
Department of Surgery, William Beaumont Hospital, Royal Oak, MI 48073, USA. rshah@beaumont.edu
Nagar
Sapna
S
Shanley
Charles J
CJ
Janczyk
Randy J
RJ
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
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors