Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Aug 9;27(1):312.
doi: 10.1186/s13054-023-04605-4.

Extracranial anticoagulant related bleedings admitted to intensive care units: a French multicenter retrospective study

Thomas Botrel  1 , Sibylle Cunat  2 , Julie Helms  2   3 , Jérémie Lemarié  4 , Jeanne Gaillon  4 , Sébastien Préau  5 , Raphael Favory  5 , Arnaud W Thille  6   7 , Florence Boissier  6   7 , Eric Maury  1   8 , Jérémie Joffre  1   8   9 , Hafid Ait-Oufella  10   11
Affiliations
Observational Study

Extracranial anticoagulant related bleedings admitted to intensive care units: a French multicenter retrospective study

Thomas Botrel et al. Crit Care. .

Abstract

Background: Anticoagulants are widely used but can lead to iatrogenic events such as bleeding. Limited data exists regarding the characteristics and management of patients admitted to intensive care units (ICU) for severe anticoagulant-related extracranial bleeding.

Methods: A retrospective observational study was conducted in five French ICUs. From January 2007 to December 2018, all patients aged over 18 years admitted to ICU for extracranial bleeding while receiving therapeutic anticoagulation were included.

Results: 486 patients were included, mainly male (61%) with an average age of 73 ± 13 years. Most patients had comorbidities, including hypertension (68%), heart disease (49%) and diabetes (33%). Patients were treated by vitamin K antagonists (VKA, 54%), heparins (25%) and direct oral anticoagulants (DOAC, 7%). The incidence of patients admitted to ICU for anticoagulant-related bleeding increased from 3.2/1000 admissions in 2007 to 5.8/1000 in 2018. This increase was particularly high for DOAC class. Upon admission, patients exhibited severe organ failure, as evidenced by a high SOFA score (7 ± 4) and requirement for organ support therapies such as vasopressors (31.5%) and invasive mechanical ventilation (34%). Adherence to guidelines for the specific treatment of anticoagulant-related bleeding was generally low. ICU mortality was 27%. In multivariate analysis, five factors were independently associated with mortality: chronic hypertension, need for vasopressors, impaired consciousness, hyperlactatemia and prolonged aPTT > 1.2.

Conclusion: Anticoagulant-related extracranial bleeding requiring ICU admission is a serious complication responsible for organ failure and significant mortality. Its incidence is rising. The therapeutic management is suboptimal and could be improved by educational programs.

Keywords: Anticoagulant; Bleeding; ICU; Outcome; Transfusion.

PubMed Disclaimer

Conflict of interest statement

No conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Annual number of patients admitted in ICU for anticoagulant-related extracranial bleeding. VKA vitamin K antagonist, DOAC direct oral anticoagulant
Fig. 2
Fig. 2
Sites of bleeding depending on type of anticoagulant. VKA vitamin K antagonist, DOAC direct oral anticoagulant
Fig. 3
Fig. 3
Multivariate analysis of factors associated with ICU mortality. CKD chronic kidney disease, VTE venous thrombo-embolic disease, RTT renal replacement therapy, MV mechanical ventilation, GCS Glasgow score, PT prothrombin time, aPTT activated partial prothrombin time, OR Odds ratio. Red circle, statistically significant association
See this image and copyright information in PMC

Comment in

References

    1. Heng C, Rybarczyk-Vigouret MC, Michel B. Anticoagulant-related hospital admissions: serious adverse reactions identified through hospital databases: admission and anticoagulant adverse reaction. Pharmacoepidemiol Drug Saf. 2015;24:144–151. doi: 10.1002/pds.3688. - DOI - PubMed
    1. Les anticoagulants en France en 2014: état des lieux, synthèse et surveillance. ANSM; 2014.
    1. Xu Y, Schulman S, Dowlatshahi D, Holbrook AM, Simpson CS, Shepherd LE, et al. Healthcare resource utilization and costs among patients with direct oral anticoagulant or warfarin-related major bleeding. Thromb Res. 2019;182:12–19. doi: 10.1016/j.thromres.2019.07.026. - DOI - PubMed
    1. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet. 2014;383:955–962. doi: 10.1016/S0140-6736(13)62343-0. - DOI - PubMed
    1. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002–2012. doi: 10.1056/NEJMsa1103053. - DOI - PubMed

Publication types