Doris Barcellona, Melis Giada, Bussu Antonio, Orrù Monica, Caddeo Maria Laura, Antonucci Emilia, Mameli Antonella, Marongiu Francesco
Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
Arianna Foundation, Bologna, Italy.
Intern Emerg Med. 2025 Aug 19. doi: 10.1007/s11739-025-04078-z.
There are no real-world data on the modalities and outcomes of managing major or life-threatening bleeding related to oral anticoagulants in the emergency room (ER). The primary endpoint of this prospective observational study was to evaluate the therapeutic regimen ER physicians started to manage bleeding and 30-day mortality. The secondary endpoint was to evaluate the appropriateness of DOACs prescription and hospital admissions. Data were collected using RedCap. Patient's general characteristics, laboratory test results, therapy started in the ER to manage bleeding, patient transfer to another hospital department or discharge home, and 30-day mortality were recorded. A total of 526 consecutive patients were enrolled, 67% treated with DOACs and 33% with VKAs. Reversal of oral anticoagulants was successfully performed in a minority of patients, while in a percentage ranging from 30.5% for dabigatran to 60.2% for VKAs, patients did not receive any treatment, even if necessary. Thirty-day mortality was 11% and 17% for patients treated with DOACs and VKAs, respectively. Major bleeding conferred a higher risk of death (OR = 2.95, 1.42-6.16). Compared with VKAs, DOACs therapy reduced the risk of death by 57% (OR = 0.43, 0.26-0.72). Excessive doses were administered to 10.8%, 13%, 18%, and 19% of patients treated with rivaroxaban, edoxaban, apixaban, and dabigatran, respectively. In these patients, major bleeding occurred in a percentage ranging from 66.7% to 94.7% depending on the drug administered. Overall, 25.8% of patients, treated primarily with DOACs, were discharged. The management of oral anticoagulant-related major or life-threatening bleeding in the ER appears poor.
关于急诊室（ER）中与口服抗凝剂相关的严重或危及生命出血的处理方式及结果，尚无真实世界的数据。这项前瞻性观察性研究的主要终点是评估急诊室医生开始用于处理出血的治疗方案及30天死亡率。次要终点是评估直接口服抗凝剂（DOACs）处方及住院治疗的合理性。数据通过RedCap收集。记录了患者的一般特征、实验室检查结果、在急诊室开始用于处理出血的治疗、患者转至其他医院科室或出院回家情况以及30天死亡率。总共纳入了526例连续患者，67%接受DOACs治疗，33%接受维生素K拮抗剂（VKAs）治疗。少数患者成功实现了口服抗凝剂的逆转，而在30.5%（达比加群）至60.2%（VKAs）的患者中，即使有必要，也未接受任何治疗。接受DOACs和VKAs治疗的患者30天死亡率分别为11%和17%。严重出血导致更高的死亡风险（比值比[OR]=2.95，1.42 - 6.16）。与VKAs相比，DOACs治疗使死亡风险降低了57%（OR = 0.43，0.26 - 0.72）。接受利伐沙班、依度沙班、阿哌沙班和达比加群治疗的患者中，分别有10.8%、13%、18%和19%服用了过量药物。在这些患者中，严重出血发生率因所服用药物不同而在66.7%至94.7%之间。总体而言，主要接受DOACs治疗的患者中有25.8%出院。急诊室中与口服抗凝剂相关的严重或危及生命出血的处理情况似乎较差。
