title: Emergency admissions for major haemorrhage associated with direct oral anticoagulants.
abstract: BACKGROUND
  To describe the population admitted in an emergency department of a teaching hospital for severe bleeding associated with direct oral anticoagulants (DOAC).
  
  
  METHODS
  During a three-year period (2012-2014) patients older than 16 years were prospectively identified by haemorrhagic symptoms from computerised requests. At least one of the following criteria defined major haemorrhage: haemorrhagic shock, unstable haemodynamic, need for transfusion or haemostatic procedure, or a life threatening location.
  
  
  RESULTS
  Fifty four patients, 23 receiving dabigatran, 30 rivaroxaban and one apixaban were included, 2 in 2012, 35 in 2013 and 17 in 2014. Median age was 84 years (range 63-99) with a sex ratio of 1.16. Haemorrhagic complications were gastrointestinal (n=27), intracranial (n=12) or miscellaneous (n=15). Indication of DOAC was stroke prevention in atrial fibrillation in 49 cases and deep vein thrombosis in 5 cases. Hospitalization was required for 45 patients (83%) with a mean length of stay of 8.5 days. Sixteen patients needed intensive care. Reversal therapy was prescribed in 11 patients. At 1 month, overall mortality was 24%, reaching 41.7% for intracranial haemorrhage. Among surviving patients, DOAC was stopped in 10 cases, continued in 17 patients and switched for other antithrombotic in 17 patients.
  
  
  CONCLUSIONS
  Our study contributes to the post marketing surveillance of major haemorrhagic complications associated with DOAC. It takes part to the knowledge about the course of this severe event in emergencies. Careful awareness in risk benefit assessment, especially in elderly, is needed.
authors.affiliation: University of Rennes 1, 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, University Hospital, Department of Pharmacology, Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D004636:Emergency Service, Hospital; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006439:Hemodynamics; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects; D020521:Stroke / Q000517:prevention & control; D020246:Venous Thrombosis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Direct oral anticoagulant; Gastrointestinal bleeding; Haemorrhage