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Get Free AccessAbstract Background The use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants. Methods We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015. Results Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16). Conclusions Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates.
Jessica Dennis, Jessica Dennis, Alejandra Medina-Rivera, Alejandra Medina-Rivera, Vinh Trương, Vinh Trương, Lina Antounians, Lina Antounians, Nora Zwingerman, Nora Zwingerman, Giovana Carrasco, Giovana Carrasco, Lisa Strug, Lisa Strug, Philip S. Wells, Philip S. Wells, France Trégouët, France Trégouët, France Morange, France Morange, Michael Wilson, Michael Wilson, France Gagnon, France Gagnon, Pierre Albaladejo, Pierre Albaladejo, Marc Samama, Marc Samama, Piérre Siè, Piérre Siè, Sophie Kauffmann, Sophie Kauffmann, Vincent Mémier, Vincent Mémier, Pierre Suchon, Pierre Suchon, Alain Viallon, Alain Viallon, Jean David, Jean David, Y Gruel, Y Gruel, Lorenn Bellamy, Lorenn Bellamy, Emmanuel de Maistre, Emmanuel de Maistre, Pauline Romegoux, Pauline Romegoux, Sophie Thoret, Sophie Thoret, Gilles Pernod, Gilles Pernod, Jean-Luc Bosson, Jean-Luc Bosson, E. V. Bazin, E. V. Bazin, Nicolas Combaret, Nicolas Combaret, A.‐L. CHERPRENET, A.‐L. CHERPRENET, Moustafa Fares, Moustafa Fares, Sophie Dufraisse, Sophie Dufraisse, Vincent Minville, Vincent Minville, Pierre‐Emmanuel Morange, Pierre‐Emmanuel Morange, Marc Léone, Marc Léone, William Cohen, William Cohen, Nadège Néant, Nadège Néant, Raphaël Marlu, Raphaël Marlu, Françoise Carpentier, Françoise Carpentier, Pascal Defaye, Pascal Defaye, Patrick Mismetti, Patrick Mismetti, Serge Molliex, Serge Molliex, Julien Lanoiselée, Julien Lanoiselée, Vincent Piriou, Vincent Piriou, Carine Delaleu-Rague, Carine Delaleu-Rague, M. Lefèvre, M. Lefèvre, Sophie Lagrange, Sophie Lagrange, L. Ardillon, L. Ardillon, Yves Ozier, Yves Ozier, Julien Bovet, Julien Bovet, A. Steib, A. Steib, Sonia Mebaouj, Sonia Mebaouj, Louis Profumo, Louis Profumo, Stéphanie Roullet, Stéphanie Roullet, David M. Smadja, David M. Smadja, Guy Meyer, Guy Meyer, Didier Journois, Didier Journois, Albert Trinh-Duc, Albert Trinh-Duc, Thibault Viard, Thibault Viard, Loïc Belle, Loïc Belle, Albrice Levrat, Albrice Levrat, Etienne Gautheron, Etienne Gautheron, Frédéric Heluwaert, Frédéric Heluwaert, S. Schlumberger, S. Schlumberger, Antonia Blanié, Antonia Blanié, Dan Benhamou, Dan Benhamou, Claire Flaujac, Claire Flaujac, Nadia Rosencher, Nadia Rosencher, Hélène Beloeil, Hélène Beloeil, Catherine Blery, Catherine Blery, Lauren Daviet, Lauren Daviet, Pierre Guéret, Pierre Guéret, David Faraoni, David Faraoni, Jean‐François Schved, Jean‐François Schved, Pauline Deras, Pauline Deras, Samir Jaber, Samir Jaber, Pierre Yves Gueugniaud, Pierre Yves Gueugniaud, Bernard Floccard, Bernard Floccard, Karim Asehnoune, Karim Asehnoune, Jérôme Paulus, Jérôme Paulus, Omar Amrani, Omar Amrani, Marie Caroline Gonthier, Marie Caroline Gonthier, Marie Geneviève Huisse, Marie Geneviève Huisse, Julien Josserand, Julien Josserand, Emmanuelle de Raucourt, Emmanuelle de Raucourt, Cécile Defournel, Cécile Defournel, Yohann Dubois, Yohann Dubois, S. Bouvier, S. Bouvier, P.M. Roy, P.M. Roy, Sigismond Lasocki, Sigismond Lasocki, Christian Carmagnac, Christian Carmagnac, Catherine Chastagner, Catherine Chastagner, J.M. Thouret, J.M. Thouret, M.-A. Sevestre, M.-A. Sevestre, Eric Meaudre, Eric Meaudre, Pierre‐Julien Cungi, Pierre‐Julien Cungi, Sophie Susen, Sophie Susen, Jean Yves Lefrant, Jean Yves Lefrant, Stéphane Macey, Stéphane Macey, Jean‐Baptiste Rieu, Jean‐Baptiste Rieu (2017). Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants. , 127(1), DOI: https://doi.org/10.1097/aln.0000000000001631.
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Type
Article
Year
2017
Authors
200
Datasets
0
Total Files
0
Language
en
DOI
https://doi.org/10.1097/aln.0000000000001631
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