title: Emergency admissions for major haemorrhage associated with antithrombotics: a cohort study.
abstract: BACKGROUND
  to describe antithrombotic-related major haemorrhage, therapeutic management and outcomes in patients admitted to an emergency department of a teaching hospital.
  
  
  METHODS
  This prospective cohort included patients older than 16years with antithrombotic-related major haemorrhage identified by monthly diagnostic codes computerised requests. Major haemorrhage was defined by at least one the following criteria: unstable hemodynamic, haemorrhagic shock, uncontrollable bleeding, need for transfusion or haemostatic procedure, or a life threatening location.
  
  
  RESULTS
  between January 1, 2011 and December 31, 2012, 913 patients met the inclusion criteria (1.2 patients per day), median age 82. Oral anticoagulants alone or in combination were used by 429 patients, antiplatelet agents (alone or dual therapy) by 420 patients, and parenteral anticoagulants by 64 patients. Major haemorrhages were: gastrointestinal bleeding (37.5%), intracranial haemorrhage (34.4%), muscular hematoma (9.4%), external haemorrhage (16.9%) and internal haemorrhage (1.9%). At 1month, 179 patients (19.8%) died, mostly patients with intracranial haemorrhage (64.2%). Prognostic factors for death were age and Glasgow coma scale at admission for intracranial haemorrhage, age and mean arterial pressure at admission for other major haemorrhages. Oral anticoagulant therapy was a predictor for death in intracranial haemorrhages. Reversal therapy was initiated in only 50.5% of patients with vitamin K antagonists, without effect on the mortality rate.
  
  
  CONCLUSIONS
  This study shows the magnitude and the severity of antithrombotic-related major haemorrhage. The high mortality rate supports careful awareness in individual risk benefit assessment, especially for elderly.
authors.affiliation: University of Rennes-1, Rennes University Hospital, Emergency Department, Rennes, France. Electronic address: Jacques.bouget@chu-rennes.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bouget
authors.affiliation: University of Rennes-1, Rennes University hospital, Department of Clinical Pharmacology, Rennes, France; INSERM, CIC-1414, Pharmacoepidemiology team (CTAD-PEPI), Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: University of Rennes-1, Rennes University Hospital, Emergency Department, Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nicolas
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: anticoagulant; antiplatelet; antithrombotic; emergency department; intracranial haemorrhage; major bleeding