Hemorrhagic Accidents to Vitamin K Antagonists: A Retrospective Study in the University Hospital of Casablanca

Abstract

Oral anticoagulation based on anti-vitamin K is prescribed in the prevention and treatment of thromboembolic events, but it could bring up a significant hemorrhagic risk. This study aims at describing the epidemiological, clinical and evolutionary features of the hemorrhagic accidents to VKA. It is a retrospective descriptive study carried out at the Cardiology Department of Casablanca’s University Hospital of IbnRochd over a two-year period including 33 patients hospitalized for AVK-hemorrhagic accidents. Asymptomatic overdoses were excluded. In our sample the average age was 50 years with a sex ratio of 1.7 (21 Male/12 Female). There has been evidence of multi-morbid field of patients with several involved histories. Acenocoumarol was the prescribed molecule for all patients. Mechanical valve prostheses were the main indication of anticoagulant treatment (60%). More than half of patients were not regularly monitored. Polymedication was found in the majority of cases (78%), with an association with amiodarone in 20% of cases, and with anti-aggregation treatment in 10% of cases. Soft parts’ Hematomas and digestive hemorrhages were the most frequent forms of hemorrhagic accidents. Hemodynamic instability was found in two patients. The therapeutic conduct was different depending upon the case, but focused on stopping AVKs, administration of vitamin K, transfusion of blood cells and fresh frozen plasma. 86% of cases displayed a good evolution, with a mortality rate of 13% during the acute phase of the hemorrhagic accident. In conclusion, prevention of these accidents is the pillar of care, which puts forward the importance of informing and educating the various stakeholders in this potentially fatal iatrogenic complication. Considering the severity of bleeding under KVA, new direct oral anticoagulants may be a good alternative in some indications.