Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, F 35043 Rennes, France.
Emergency Department, Rennes University Hospital, F 35033 Rennes, France.
Thromb Res. 2021 Mar;199:54-58. doi: 10.1016/j.thromres.2020.12.022. Epub 2020 Dec 26.
There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants.
To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality.
Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Clinical and biological data, therapeutic management of the bleeding event, and in-hospital mortality were collected from the medical records and compared across five groups of hematoma locations. Potential confounders were taken in account using a multivariate binomial regression model.
Three hundred and seventy-five patients were included (mean age = 81.4 years): 271 were exposed to vitamin K antagonists, 58 to parenteral anticoagulants (heparin, LMWH, fondaparinux), 33 to antiplatelets, and 13 to direct oral anticoagulants. The muscular hematomas were located in the lower limbs (n = 198), the rectus sheath (n = 71), the iliopsoas (n = 45), the upper limbs (n = 33), or elsewhere (n = 28). Reversal therapy was prescribed for 48.5% of patients, red cell transfusions for 63.6%, surgery for 12.3% and embolization for 3.5%. For 84% of patients, hospitalization was required, with a median length of stay of 10 days. Overall, in-hospital mortality was 8.5%. Reversal therapy, the need for intensive care and mortality were significantly more frequent among patients with iliopsoas hematomas. The independent predictors of in-hospital mortality were: decrease in mean arterial pressure (RR = 1.84), decrease in hemoglobin level (RR = 1.37) and the iliopsoas location (RR = 3.06).
Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes.
关于主要肌肉血肿的数据很少，而且现有的数据主要集中在接受口服抗凝剂治疗的患者身上。
描述因抗血栓药物而导致主要肌肉血肿并收入急诊科的患者的临床特征、治疗方法和结局，并确定院内死亡的预测因素。
在三年期间，前瞻性地连续收集了在五家三级保健医院因接受抗血栓药物治疗而导致主要肌肉血肿的成年患者，并对其进行了医学验证。从病历中收集了临床和生物学数据、出血事件的治疗管理以及院内死亡率，并比较了血肿位置的五个组。使用多变量二项回归模型考虑了潜在的混杂因素。
共纳入 375 例患者（平均年龄 81.4 岁）：271 例患者接受维生素 K 拮抗剂治疗，58 例患者接受静脉抗凝剂（肝素、低分子肝素、磺达肝素）治疗，33 例患者接受抗血小板治疗，13 例患者接受直接口服抗凝剂治疗。肌肉血肿位于下肢（198 例）、腹直肌鞘（71 例）、髂腰肌（45 例）、上肢（33 例）或其他部位（28 例）。48.5%的患者接受了逆转治疗，63.6%的患者接受了红细胞输注，12.3%的患者接受了手术治疗，3.5%的患者接受了栓塞治疗。84%的患者需要住院治疗，中位住院时间为 10 天。总体而言，院内死亡率为 8.5%。接受逆转治疗、需要重症监护和死亡的患者中，髂腰肌血肿患者明显更多。院内死亡的独立预测因素是：平均动脉压下降（RR=1.84）、血红蛋白水平下降（RR=1.37）和髂腰肌位置（RR=3.06）。
因抗血栓药物导致主要肌肉血肿的体弱老年患者存在严重的发病率和院内死亡率风险。髂腰肌部位是最具威胁生命的出血部位。需要密切观察此类人群，以确保更好的结局。
