Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s’est-elle améliorée au fil du temps ?

Abstract

Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s'est-elle améliorée au fil du temps ?Has the management of bleeding related to VKA, and treated with prothrombin complex concentrate, improved over time in emergency departments?Abstract Aims: Bleeding is a serious and potentially fatal complication of VKA, and represents in France, the main cause of hospitalisations for severe iatrogenic accidents. The aim of our study was to assess the compliance of the French guidelines for the management of patients, treated with prothrombin complex concentrate (PCC) for severe hemorrhage associated with VKA, over time in emergency departments (ED). Procedure: This was a two-center observational and retrospective study. Patients who consulted in the ED in 2006, 2009 and 2012 for severe bleeding due to VKA, and who underwent reversal with PCC (centralized orders from the pharmacy), were included. Results: A total of 58 patients met the inclusion criteria. The mean age was 77 years. The leading cause of oral anticoagulation was atrial fibrillation. The main sites of bleeding were abdominal (37%) and intracranial (19%). The average time for PCC prescription was estimated to 146 minutes without any significant change over the time (138 in 2006, concomitantly with PCC in 40 of the 58 included patients (43% in 2006, 80% in 2009 and 68% in 2012). Conclusion: Our results showed no improvement for the management of severe hemorrhage in VKA treated patients over time.