Clinical management and outcome of major bleeding in patients on treatment with vitamin K antagonists.
BACKGROUND
The optimal management of major bleeding associated with vitamin K antagonists remains unclear.


OBJECTIVE
The aim of the study was to assess the determinants of outcome of vitamin K antagonists-associated major bleeding and the outcome of bleeding in relation with the therapeutic management.


METHODS
Patients hospitalized for major bleeding while on vitamin K antagonists were included in a prospective, cohort study. Major bleeding was defined according to the criteria of the International Society of Thrombosis Haemostasis. The primary study outcome was death at 30days from major bleeding.


RESULTS
544 patients were included in this study, of which 282 with intracranial hemorrhage. Prothrombin complex concentrates were used in 51% and in 23% of patients with intracranial hemorrhage or non-intracranial major bleeding, respectively (p<0.001); fresh frozen plasma was used in 7% and in 17% of patients with intracranial hemorrhage or non-intracranial major bleeding (p<0.001). Death at 30days occurred in 100 patients (18%), 72 patients with intracranial hemorrhage and 28 patients with non-intracranial major bleeding. Age over 85years, low Glasgow Coma Scale score and shock were independent predictors of death at 30days. Invasive procedures were associated with decreased risk of death.


CONCLUSIONS
Among the patients hospitalized for major bleeding while on vitamin K antagonists, the risk for death is substantial. The risk for death is associated with the clinical severity of major bleeding as assessed by the GCS score and by the presence of shock more than with the initial localization of major bleeding (ICH vs other sites).
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy. Electronic address: cecilia.becattini@unipg.it.
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Becattini
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy.
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Franco
Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy.
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Masotti
Emergency Medicine, Ospedali Riuniti Umberto I - Lancisi - Salesi, Ancona, Italy.
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Nitti
Emergency Medicine, Ospedale Cattinara, Trieste, Italy.
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Cattinelli
Internal Medicine, University of Siena, Italy.
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Cappelli
Emergency Medicine, Policlinico Maggiore, Milano, Italy.
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Manina
Emergency Medicine, Santa Maria della Misericordia Hospital, Udine, Italy.
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Sbrojavacca
Internal Medicine, Santa Croce Hospital, Cuneo, Italy.
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Pomero
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Italy.
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Agnelli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D015600:Glasgow Coma Scale; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000401:mortality* / Q000628:therapy*; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D005343:Fibrinolytic Agents; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin
Anticoagulants; Hemorrhage; Prognosis; Stroke; Warfarin