Extracranial anticoagulant related bleedings admitted to intensive care units: a French multicenter retrospective study
Thomas Botrel,
Sibylle Cunat,
Julie Helms,
Jérémie Lemarié,
Jeanne Gaillon,
Sébastien Préau,
Raphael Favory,
Arnaud W. Thille,
Florence Boissier,
Eric Maury,
Jérémie Joffre,
Hafid Ait-Oufella
Affiliations
Thomas Botrel
Medical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University
Sibylle Cunat
Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil
Julie Helms
Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil
Jérémie Lemarié
Intensive Care Department, Nantes University Hospital
Jeanne Gaillon
Intensive Care Department, Nantes University Hospital
Sébastien Préau
Intensive Care Department, CHU Lille, Univ. Lille, RID-AGE, INSERM UMR 1167, Institut Pasteur
Raphael Favory
Intensive Care Department, CHU Lille, Univ. Lille, RID-AGE, INSERM UMR 1167, Institut Pasteur
Arnaud W. Thille
Intensive Care Department, Centre Hospitalo-Universitaire de Poitiers
Florence Boissier
Intensive Care Department, Centre Hospitalo-Universitaire de Poitiers
Eric Maury
Medical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University
Jérémie Joffre
Medical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University
Hafid Ait-Oufella
Medical Intensive Care Unit, Intensive Care Department, Saint Antoine University Hospital, APHP, Sorbonne University
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.
