Service des urgences Adultes, CHU Clermont-Ferrand, Clermont-Ferrand (63), France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.
Service des urgences Adultes, CHU Clermont-Ferrand, Clermont-Ferrand (63), France.
Am J Emerg Med. 2018 Jul;36(7):1257-1261. doi: 10.1016/j.ajem.2018.03.067. Epub 2018 Mar 27.
According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding.
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.
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.
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 75.5years (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.
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.
根据国际血栓与止血学会（ISTH）的标准，没有其他严重程度标准的肌内血肿不被认为是大出血。
在因维生素 K 拮抗剂（VKA）逆转而接受肌内血肿治疗的大型 VKA 患者队列中，我们根据是否符合 ISTH 标准评估频率、严重程度和抗凝管理。
我们进行了一项回顾性单中心研究，纳入因 VKA 诱导的肌内血肿而入住急诊室并接受凝血酶原复合物浓缩物逆转出血的患者。
在研究期间，我们的急诊室共发生 631 例 VKA 诱导的出血事件，其中 73 例（11.6%）为肌内血肿，半数符合 ISTH 标准。患者平均年龄为 75.5 岁（95%CI=72.6-78.3）。入院时的血液检查显示，符合 ISTH 标准的患者国际标准化比值（INR）更高（7.0±4.6 vs. 4.1±3.0，p=0.002），血红蛋白水平更低（8.1±1.8 vs. 11.9±2.2，p<0.001）。符合 ISTH 标准的患者更有可能出现髂腰肌、臀肌和胸肌肌内血肿，而不符合 ISTH 标准的患者则更有可能出现股四头肌肌内血肿。有趣的是，三分之二的腹直肌鞘血肿患者不符合 ISTH 标准。然而，符合或不符合 ISTH 标准的患者住院时间和再出血率相似。
我们发现，一半因肌内血肿入院的患者不符合 ISTH 标准的大出血。有趣的是，这些患者的住院时间和再出血率与符合 ISTH 标准的大出血患者相似。
