title: Severe Extra-Cerebral Anticoagulant-Related Bleeding in Intensive Care Unit: A Retrospective Study From 2000 to 2013.
abstract: Bleeding is the most frequent complication of anticoagulant therapy, responsible for a number of hospitalizations or deaths. However, studies describing the management and prognosis factors of extra-cerebral anticoagulant-related bleedings in intensive care unit (ICU) are lacking.Retrospective observational study in an 18-bed ICU in a tertiary teaching hospital. From January 2000 to December 2013, all consecutive patients, older than 18 years, admitted for severe anticoagulant-related bleeding (SAB) except intracerebral site were included.A total of 100 patients were included, the mean age was 77 ± 11 years and 62% were women. SAB incidence in ICU doubled over 10 years (P = 0.03). In ICU, the average length of stay was 5 ± 6 days and mortality was 30%. Nonsurviving patients had a higher SAPS II (78 ± 24 vs 53 ± 24, P < 0.0001), a higher SOFA (9.0 ± 3.6 vs 4.7 ± 3.4, P < 0.0001) and received more frequently support therapy such as mechanical ventilation (87% vs 16%, P < 0.0001) and vasopressors (90% vs 27%, P < 0.0001). The volume of blood-derived products transfused was more important in nonsurvivors mainly during the first 24 hours of resuscitation. Rapid anticoagulant reversal therapy was associated with better prognosis (ICU survivors 66% vs 39%, Fisher test P = 0.04). Anterior abdominal wall was identified as a frequent site of bleeding (22%) due to epigastric artery injury during subcutaneous injection of heparin and was associated with a large mortality (55%).Extra-cerebral SAB is a life-threatening complication that requires rapid resuscitation and anticoagulant reversal therapy. Injection of heparin should be done carefully in the subcutaneous tissue thereby avoiding artery injury.
authors.affiliation: From the AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale (MH, CP, SB, NB, JB, EM, BG, HA-O), Inserm U970, Paris Research Cardiovascular Center (HA-O), AP-HP, Hôpital Saint-Antoine, Service de Santé Publique (PB), Université Pierre et Marie Curie-Paris 6 (PB, CP, EM, BG, HA-O), and UMRS_1136, Paris, France (PB, EM, BG).
authors.forename: M
authors.initials: M
authors.lastname: Hauguel
authors.forename: Py
authors.initials: P
authors.lastname: Boelle
authors.forename: C
authors.initials: C
authors.lastname: Pichereau
authors.forename: S
authors.initials: S
authors.lastname: Bourcier
authors.forename: N
authors.initials: N
authors.lastname: Bigé
authors.forename: J L
authors.initials: JL
authors.lastname: Baudel
authors.forename: E
authors.initials: E
authors.lastname: Maury
authors.forename: B
authors.initials: B
authors.lastname: Guidet
authors.forename: H
authors.initials: H
authors.lastname: Ait-Oufella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants