title: [Retrospective study about 73 consecutive patients treated by direct oral anticoagulant and admitted to an emergency room].
abstract: BACKGROUND
  Direct oral anticoagulants are a recent alternative to vitamin K antagonists but there is a lack of data regarding patients receiving these new types of treatment. The aim of the study was to identify and describe patients receiving direct oral anticoagulants admitted to an emergency unit.
  
  
  METHODS
  All the patients taking direct oral anticoagulants, admitted to the emergency room of the Clermont-Ferrand Hospital from January to August 2013, were included in this retrospective and descriptive study.
  
  
  RESULTS
  Among the 73 patients included, 47.9% were treated with dabigatran and 52.1% with rivaroxaban. The indication was stroke prevention in 62 patients with atrial fibrillation whose average CHADS2 score was 2.6 [2.3-3](IC95%). The average age was 76.4 years [73.7-79.1](IC95%). Twenty-nine patients (39.7%) had at least one drug association known for increasing the risk of bleeding. Average scores for bleeding risk were: HAS-BLED 3.1 [2.9-3.3](IC95%) and Beyth 1.5 [1.3-1.6](IC95%). Bleeding patients included a higher percentage of men (68.8 vs. 38.2%, P=0.032). Creatinine clearance was lower in patients with major bleeding (45.2% vs. 68.8 mL/min, P=0.002). The Beyth score was highest in both sub-groups.
  
  
  CONCLUSIONS
  In our study, we have found that the bleeding risk factors were: male gender, a high Beyth score, and a lowered creatinine clearance. Overall, patients treated with direct oral anticoagulants admitted to the emergency room were old with many co-morbidities, especially cardiovascular conditions; polymedication was frequent.
authors.affiliation: Service des urgences, pôle SAMU-SMUR-urgences, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France. Electronic address: fmoustafa@chu-clermontferrand.fr.
authors.forename: F
authors.initials: F
authors.lastname: Moustafa
authors.affiliation: Service des urgences, pôle SAMU-SMUR-urgences, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: G
authors.initials: G
authors.lastname: Milhaud
authors.affiliation: Service des urgences, pôle SAMU-SMUR-urgences, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France; Université d'Auvergne, Clermont-I, UFR de médecine, 28, place Henri-Dunant BP 38, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: N
authors.initials: N
authors.lastname: Dublanchet
authors.affiliation: Laboratoire d'hématologie biologique, CHU Estaing, place Lucie-et-Raymond-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, Clermont-I, UFR de médecine, 28, place Henri-Dunant BP 38, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Lebreton
authors.affiliation: Service des urgences, pôle SAMU-SMUR-urgences, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: F
authors.initials: F
authors.lastname: Dutheil
authors.affiliation: Service des urgences, pôle SAMU-SMUR-urgences, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France; Université d'Auvergne, Clermont-I, UFR de médecine, 28, place Henri-Dunant BP 38, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D000069604:Dabigatran; D004347:Drug Interactions; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D049690:History, Ancient; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D000069552:Rivaroxaban; D020521:Stroke / Q000517:prevention & control; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulant oral direct; Bleeding; Direct oral anticoagulant; Emergency; Hemorrhage; Hémorragie; Urgence