title: Severe non-traumatic bleeding events detected by computed tomography: do anticoagulants and antiplatelet agents have a role?
abstract: OBJECTIVE
  Bleeding is the most common and most serious complication of anticoagulant (AC) and antiplatelet agents (APA) which are increasingly used in every day practice. The aim of this study was to enlist and analyze the most severe bleeding events revealed during computed tomography scanner (CT scan) examinations over a 1-year period at our University Hospital and to evaluate the role of ACs and APAs in their occurrence.
  
  
  METHODS
  This descriptive monocentric retrospective study included all patients who benefited from an emergency CT scan with a diagnosis of severe non-traumatic bleeding. Patients were divided into two groups: those treated with ACs and/or APAs, and those not treated with ACs or APAs.
  
  
  RESULTS
  After applying the inclusion criteria, 93 patients were enrolled. Sixty-one patients received an anticoagulant or antiplatelet treatment, and 32 did not receive any AC or APA therapy. Seventy nine percent presented with an intracranial hemorrhage, 17% with a rectus sheath or iliopsoas bleeding or hematoma, and 4% with a quadriceps hematoma. Only patients who received ACs or APAs suffered a muscular hematoma (p < 0.0001). Among patients treated with vitamin K antagonists, 6/43 (14%), had an international normalized ratio (INR) higher than the therapeutic range (INR > 3).
  
  
  CONCLUSIONS
  In our series, intracranial hemorrhage was preponderant and muscular hematomas occurred exclusively in patients treated with ACs and/or APAs. This study needs to be extended to evaluate the impact of new anticoagulant and antiplatelet agents.
authors.forename: Olivier
authors.initials: O
authors.lastname: Risch
authors.forename: Agaicha
authors.initials: A
authors.lastname: Alfidja
authors.forename: Aurelien
authors.initials: A
authors.lastname: Mulliez
authors.forename: Anderson H
authors.initials: AH
authors.lastname: Amani
authors.forename: Louis
authors.initials: L
authors.lastname: Boyer
authors.forename: Lionel
authors.initials: L
authors.lastname: Camilleri
authors.affiliation: Heart surgery Department, G, Montpied Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France. kazarnoush@chu-clermontferrand.fr.
authors.forename: Kasra
authors.initials: K
authors.lastname: Azarnoush
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors