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Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma
Moustafa, F. Poujol, L. Vincent, N. Saint-Denis, Jennifer Dublanchet, N. Breuil, N. Heuser, S. Lebreton, A. Dutheil, Frederic Schmidt, Jeannot
Moustafa, F.
Poujol, L.
Vincent, N.
Saint-Denis, Jennifer
Dublanchet, N.
Breuil, N.
Heuser, S.
Lebreton, A.
Dutheil, Frederic
Schmidt, Jeannot
Abstract
Background According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. Objectives: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. Materials and methods We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. Results During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5 years (95% CI = 72.6–78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0 ± 4.6 vs. 4.1 ± 3.0, p = 0.002) and lower hemoglobin (8.1 ± 1.8 vs. 11.9 ± 2.2, p < 0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding. Conclusion We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.
Keywords
oral anticoagulant, VKA, major bleeding, intramuscular hematoma, ISTH criteria
Date
2018
Type
Journal article
Journal
American Journal of Emergency Medicine
Book
Volume
36
Issue
7
Page Range
1257-1261
Article Number
ACU Department
Non-faculty
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled