Hospital Quality Foundation, Shrewsbury, NJ, United States of America.
Ben Taub General Hospital, Baylor College of Medicine, Houston, TX, United States of America.
Am J Emerg Med. 2020 Jun;38(6):1163-1170. doi: 10.1016/j.ajem.2019.12.023. Epub 2019 Dec 28.
The Safety of Oral Anticoagulants Registry (SOAR) was designed to describe the evaluation and management of patients with oral anticoagulant (OAC)-related major bleeding or bleeding concerns who present to the emergency department (ED) with acute illness or injury. Patients in the ED are increasingly taking anticoagulants, which can cause bleeding-related complications as well as impact the acute management of related or unrelated clinical issues that prompt presentation. Modifications of emergency evaluation and management due to anticoagulation have not previously been studied.
This was a multicenter observational in-hospital study of patients who were judged to be experiencing an active OAC effect and had (a) an obvious bleeding event or (b) were deemed at risk for serious bleeding spontaneously, after injury, or during an indicated invasive procedure. Diagnostic testing, therapies employed, and clinical outcomes were collected.
Thirty-one US hospitals contributed data to SOAR. Of 1513 subjects, acute hemorrhage (AH) qualified 78%, while 22% had a bleeding concern (BC). Warfarin was the index OAC in 37.3%, dabigatran in 13.3%, and an anti-Factor X in 49.4%. The most common sites of AH were gastrointestinal (51.0%) and intracranial (26.8%). In warfarin-treated patients, the mean (IQR) presenting INR was 3.1 (2.2, 4.8) in AH patients and 3.9 (2.4, 7.2) in BC patients. Three-fifths of SOAR patients were treated with factor repletion or specific reversal agents, and those patients had a longer length of stay. In addition, seven (0.76%) of the treated patients experienced an in-hospital thrombotic complication; two of these seven died on the index admission, both of fatal pulmonary embolism. Vitamin K was used and dosed inconsistently in both warfarin and NOAC cohorts.
Care of anticoagulated patients in the acute care setting is inconsistent, reflecting the diversity of presentation. As the prevalence of OAC use increases with the aging of the US population, further study and targeted educational efforts are needed to drive more evidence-based care of these patients.
口服抗凝剂登记处（SOAR）旨在描述在急诊就诊的有口服抗凝剂（OAC）相关大出血或出血担忧的患者的评估和管理，这些患者有急性疾病或损伤。越来越多的急诊患者正在服用抗凝剂，这可能会导致出血相关并发症，同时影响提示就诊的相关或无关的临床问题的急性管理。此前尚未研究过由于抗凝而对急诊评估和管理的修改。
这是一项多中心观察性院内研究，纳入了被认为正在经历 OAC 作用的患者，这些患者有 (a) 明显的出血事件或 (b) 在受伤后或在有指征的侵入性操作期间因自发性、有严重出血风险。收集了诊断性检查、采用的治疗方法和临床结局。
31 家美国医院为 SOAR 提供了数据。在 1513 名患者中，急性出血 (AH) 占 78%，而有出血担忧 (BC) 的占 22%。华法林是 37.3%的索引 OAC，达比加群是 13.3%，抗因子 X 是 49.4%。AH 的最常见部位是胃肠道（51.0%）和颅内（26.8%）。在华法林治疗的患者中，AH 患者的平均（IQR）INR 为 3.1（2.2，4.8），BC 患者为 3.9（2.4，7.2）。SOAR 患者中有五分之三接受了因子补充或特定逆转剂治疗，这些患者的住院时间更长。此外，7 名（0.76%）接受治疗的患者发生了院内血栓并发症；其中 2 人在指数入院时死亡，均死于致命性肺栓塞。维生素 K 在华法林和 NOAC 两组中的使用和剂量均不一致。
在急性护理环境中，抗凝患者的护理不一致，反映了表现的多样性。随着美国人口老龄化，OAC 使用的增加，需要进一步研究和有针对性的教育努力，以推动这些患者更基于证据的护理。
