Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland.
University Institute of Clinical Chemistry, Inselspital Bern University Hospital, and University of Bern, Bern University, Bern, Switzerland.
BMC Emerg Med. 2021 Sep 18;21(1):105. doi: 10.1186/s12873-021-00497-1.
Up to a fourth of patients at emergency department (ED) presentation suffer from acute deterioration of renal function, which is an important risk factor for bleeding events in patients on oral anticoagulation therapy. We hypothesized that outcomes of patients, bleeding characteristics, therapy, and outcome differ between direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs).
All anticoagulated patients older than 17 years with an impaired kidney function treated for an acute haemorrhage in a large Swiss university ED from 01.06.2012 to 01.07.2017 were included in this retrospective cohort study. Patient, treatment, and bleeding characteristics as well as outcomes (length of stay ED, intensive care unit and in-hospital admission, ED resource consumption, in-hospital mortality) were compared between patients on DOAC or VKA anticoagulant.
In total, 158 patients on DOAC and 419 patients on VKA with acute bleeding and impaired renal function were included. The renal function in patients on VKA was significantly worse compared to patients on DOAC (VKA: median 141 μmol/L vs. DOAC 132 μmol/L, p = 0.002). Patients on DOAC presented with a smaller number of intracranial bleeding compared to VKA (14.6% DOAC vs. 22.4% VKA, p = 0.036). DOAC patients needed more emergency endoscopies (15.8% DOAC vs, 9.1% VKA, p = 0.020) but less interventional emergency therapies to stop the bleeding (13.9% DOAC vs. 22.2% VKA, p = 0.027). Investigated outcomes did not differ significantly between the two groups.
DOAC patients were found to have a smaller proportional incidence of intracranial bleedings, needed more emergency endoscopies but less often interventional therapy compared to patients on VKA. Adapted treatment algorithms are a potential target to improve care in patients with DOAC.
多达四分之一的急诊科（ED）就诊患者的肾功能急性恶化，这是口服抗凝治疗患者出血事件的重要危险因素。我们假设，直接口服抗凝剂（DOAC）和维生素 K 拮抗剂（VKA）之间的患者结局、出血特征、治疗和结局存在差异。
本回顾性队列研究纳入了 2012 年 6 月 1 日至 2017 年 7 月 1 日期间，在瑞士一所大型大学 ED 因急性出血接受治疗且肾功能受损的年龄大于 17 岁的所有抗凝治疗患者。比较了 DOAC 或 VKA 抗凝患者的患者、治疗和出血特征以及结局（ED 住院时间、重症监护病房和住院、ED 资源消耗、院内死亡率）。
共纳入 158 例 DOAC 患者和 419 例 VKA 患者，两组均因急性出血且肾功能受损。VKA 患者的肾功能明显较 DOAC 患者差（VKA：中位数 141μmol/L 比 DOAC 132μmol/L，p=0.002）。与 VKA 相比，DOAC 患者颅内出血的数量更少（14.6% DOAC 比 22.4% VKA，p=0.036）。DOAC 患者需要更多的紧急内镜检查（15.8% DOAC 比 9.1% VKA，p=0.020），但需要较少的介入紧急治疗来止血（13.9% DOAC 比 22.2% VKA，p=0.027）。两组的调查结局无显著差异。
与 VKA 相比，DOAC 患者颅内出血的比例发生率较低，需要更多的紧急内镜检查，但较少需要介入治疗。调整后的治疗方案可能是改善 DOAC 患者治疗的潜在目标。
