Complication Of Anticoagulant Therapy Research Articles

Spontaneous retroperitoneal haemorrhage after pulmonary endarterectomy surgery

Spontaneous retroperitoneal hematoma (SRH) is a rare complication of anticoagulation therapy. Presentation may vary from limb paresis to hypovolemic shock due to blood loss. The optimal treatment is controversial. It can be managed conservatively or surgically. We report a case of a 73-year-old man presenting with progressively worsening abdominal pain and severe pain radiating to his left lower limb twenty-five days after his pulmonary endarterectomy (PEA) surgery. He was on anticoagulation per our institutional protocol for PEA patients. Investigations revealed a large, spontaneously occurring iliopsoas hematoma. Our patient was treated conservatively, and the SRH stabilised.

Intestinal intramural hematoma: A rare complication of Anticoagulation Therapy

Objective: Anticoagulant therapy is commonly used in the treatment of cardiac and thromboembolic diseases, with bleeding being the most common side effect, which increases in likelihood with prolonged usage. Intestinal intramural hematoma, although rare, is a potential complication of anticoagulant therapy. Case: Herein, we present the case of a 49-year-old male patient who presented to our outpatient general surgery clinic with complaints of nausea, vomiting, and abdominal pain. Upon examination, electrocardiography (ECG) revealed sinus rhythm without any ischemic changes, and echocardiography findings were within normal limits. The patient reported the use of warfarin, and his International Normalized Ratio (INR) was found to be 14.7 (normal range: 0.8-1.1). A 10 mg (1 ampoule) intravenous (IV) infusion of vitamin K was administered, and the warfarin dosage was adjusted accordingly. Subsequent follow-up assessments showed normalization of the INR levels. Conclusion: Intestinal intramural hematoma is an exceedingly rare condition that necessitates prompt diagnosis and intervention, as delayed recognition can lead to life-threatening complications. Clinicians should maintain a high index of suspicion for intestinal obstruction secondary to anticoagulant therapy in patients presenting to the emergency department with symptoms such as abdominal pain, nausea, and vomiting.

Central American and Caribbean Consensus Document for the Optimal Management of Oral Anticoagulation in Patients with Non-Valvular Atrial Fibrillation Endorsed by the Central American and Caribbean Society of Arterial Hypertension and Cardiovascular Prevention.

Atrial fibrillation (AF) is the most common arrhythmia in adults. Prevention of the ischaemic risk with oral anticoagulants (OACs) is widely recommended, and current clinical guidelines recommend direct oral anticoagulants (DOACs) as preference therapy for stroke prevention. However, there are currently no clinical practice guidelines or recommendation documents on the optimal management of OACs in patients with AF that specifically address and adapt to the Central American and Caribbean context. The aim of this Delphi-like study is to respond to doubts that may arise in the management of OACs in patients with non-valvular AF in this geographical area. A consensus project was performed on the basis of a systematic review of the literature, a recommended ADOLOPMENT-like approach, and the application of a two-round Delphi survey. In the first round, 31 recommendations were evaluated and 30 reached consensus, of which, 10 unanimously agreed. The study assessed expert opinions in a wide variety of contextualized recommendations for the optimal management of DOACs in patients with non-valvular atrial fibrillation (NVAF). There is a broad consensus on the clinical practice guideline (CPG) statements used related to anticoagulation indication, patient follow-up, anticoagulation therapy complications, COVID-19 management and prevention, and cardiac interventions.

Anticoagulant-Related Nephropathy in a Patient on Coumadin

Abstract Introduction/Objective Anticoagulant therapy is commonly used to prevent stroke and systemic embolism in patients with atrial fibrillation. However, it carries the risk of bleeding and can lead to serious complications such as anticoagulant-related nephropathy (ARN), a recently described entity characterized by hematuria and acute kidney injury. This report presents a case of a 79-year-old male with a history a patient with a history of atrial fibrillation on coumadin, highlighting the importance of monitoring for anticoagulant-related complications and the need for prompt diagnosis and management to prevent further renal damage. Methods/Case Report The kidney biopsy showed evidence of underlying hypertensive and diabetic nephropathy, with nodular and global glomerulosclerosis, moderate to marked interstitial fibrosis, and tubular atrophy along with many red cell casts of variable ages in the tubules indicative of anticoagulant-related nephropathy. Additionally, one glomerulus had a partial cellular crescent associated with a focus of blood clot, likely related to heavy hematuria. Patient is seronegative for ANCA. The immunofluorescence microscopy is non-contributory due to absence of glomerulus in the sample. Electron microscopy showed diffuse foot process effacement and microvillous transformation of podocytes, increased mesangial matrix, and thickened glomerular basement membranes, but no immune complex deposits. these ultrastructural features confirm the background diabetic nephropathy. Results (if a Case Study enter NA) NA Conclusion Anticoagulant-related nephropathy (ARN) is a rare but serious complication of anticoagulation therapy that can result in hematuria and acute kidney injury. Our case highlights the importance of monitoring for anticoagulant-related complications, especially in high-risk patients with multiple comorbidities. Prompt diagnosis and management of ARN is essential to prevent further renal damage. In this case, despite initial improvement with vitamin K therapy, the patient developed severe renal dysfunction requiring dialysis and renal biopsy. This emphasizes the need for increased awareness and early recognition of ARN in patients on anticoagulant therapy.

A Combination of Ex Vivo and In Vivo Strategies for Evaluating How Much New Oral Anticoagulants Exacerbate Experimental Intracerebral Bleeding

Background Intracerebral hemorrhage is the most serious complication of anticoagulant therapy but the effects of different types of oral anticoagulants on the expansion of these hemorrhages are still unclear. Clinical studies have revealed controversial results; more robust and long-term clinical evaluations are necessary to define their outcomes. An alternative is to test the effect of these drugs in experimental models of intracerebral bleeding induced in animals. Aims To test new oral anticoagulants (dabigatran etexilate, rivaroxaban, and apixaban) in an experimental model of intracerebral hemorrhage induced by collagenase injection into the brain striatum of rats. Warfarin was used for comparison. Methods Ex vivo anticoagulant assays and an experimental model of venous thrombosis were employed to determine the doses and periods of time required for the anticoagulants to achieve their maximum effects. Subsequently, volumes of brain hematoma were evaluated after administration of the anticoagulants, using these same parameters. Volumes of brain hematoma were evaluated by magnetic resonance imaging, H&E (hematoxylin and eosin) staining, and Evans blue extravasation. Neuromotor function was assessed by the elevated body swing test. Results and Conclusions The new oral anticoagulants did not increase intracranial bleeding compared with control animals, while warfarin markedly favored expansion of the hematomas, as revealed by magnetic resonance imaging and H&E staining. Dabigatran etexilate caused a modest but statistically significant increase in Evans blue extravasation. We did not observe significant differences in elevated body swing tests among the experimental groups. The new oral anticoagulants may provide a better control over a brain hemorrhage than warfarin.

#3232 ANTICOAGULANT RELATED NEPHROPATHY – AN UNDERDIAGNOSED COMPLICATION

Abstract Background and Aims Anticoagulant-related nephropathy (ARN) is an underdiagnosed complication of anticoagulant therapy (AT). Method We report 3 cases of ARN. Patient 1: 31 year-old male (M), kidney transplanted for reflux nephropathy, with normal renal function (Rfx) and urinalysis (U), on therapy with tacrolimus (FK), everolimus and mycophenolate. He started edoxaban (E) (60 mg od) for deep vein thrombosis (DVT). After 10 days he developed hematuria and Acute Kidney Injury (AKI). Ruled out urological and infectious causes, we performed kidney biopsy (KB) which showed extensive tubular necrosis (TN), erythrocyte casts (cRBC) and glomerular hemorrhage (EG). Perl's stain (PS) showed iron deposits in tubular cells released by erythrocytes lysis (Fig. 1). Although E posology was adequate the concomitant intake of FK by reducing CYP3A4 metabolism of E resulted in over anticoagulation (OAC), demonstrated by the dosage of the factor Xa (FXa) at peak. Upon withdrawal of AT, Rfx and U normalized. Patient 2: 73-year-old M with hypertension and mild chronic kidney disease (CKD) on antiplatelet therapy (ASA 100 mg od) for biological valve prosthesis and AT with Enoxaparin sodium (Es) (4000UI od) for DVT prophylaxis. He was admitted to the hospital for fever and hypotensive episodes. Microbiological, neoplastic and immune investigations were negative. A progressive worsening of Rfx associated with macro-hematuria was observed, requiring renal replacement therapy (RRT). KB showed a post-infectious glomerulonephirits, but in the hypothesis that tubular damage was enhanced by antiplatelet/AT, PS was performed and resulted positive. OAC was confirmed by the dosage of the factor Xa (FXa) at peak. After withdrawal of therapy, progressive improvement of the Rfx and hematuria were observed, such as to allow the suspension of the RRT. Patient 3: 54 year-old M with kidney and lung involvement of ANCA-associated vasculitis. After rituximab induction therapy he showed marked improvement on lung and renal function and antibody titer (c-ANCA PR3 positive). He experienced an unusual worsening of Rfx and hematuria after starting a AT (Es 6000 UI BID) to treat a DVT. A KB was performed in the suspicion of ARN. The histology revealed an extensive TN, numerous cRBC with extracapillary glomerulonephritis and PS positive. IF was negative. OAC was confirmed and adjustment of anticoagulation dose for glomerular filtration rate resulted in improvement of Rfx. Results ARN is a not uncommon occurrence in cases of OAC and glomerular fragility (Table 1). Conclusion ARN should be suspected in predisposed patients in whom glomerular hyperfiltration or preexisting GN during OAC facilitate EG. Attention should be given to drug interactions that can induce an unrecognized OAC. The cases described underline the need for careful monitoring of U, RFx and FXa activity to promptly treat this complication, avoiding permanent damage.

Comparison of landiolol and amiodarone for the treatment of new-onset atrial fibrillation after cardiac surgery (FAAC) trial: study protocol for a randomized controlled trial

BackgroundPostoperative atrial fibrillation (PoAF) after cardiac surgery has a high incidence of 30%, but its management is controversial. Two strategies are recommended without evidence of a superiority of one against the other: rate control with beta-blocker or rhythm control with amiodarone. Landiolol is a new-generation beta-blocker with fast onset and short half-life. One retrospective, single-center study compared landiolol to amiodarone for PoAF after cardiac surgery with a better hemodynamic stability and a higher rate of reduction to sinus rhythm with landiolol, justifying the need for a multicenter randomized controlled trial. Our aim is to compare landiolol to amiodarone in the setting of PoAF after cardiac surgery with the hypothesis of a higher rate of reduction to sinus rhythm with landiolol during the 48 h after the first episode of POAF.MethodsThe FAAC trial is a multicenter single-blind two parallel-arm randomized study, which planned to include 350 patients with a first episode of PoAF following cardiac surgery. The duration of the study is 2 years. The patients are randomized in two arms: a landiolol group and an amiodarone group.Randomization (Ennov Clinical®) is performed by the anesthesiologist in charge of the patient if PoAF is persistent for at least 30 min after correction of hypovolemia, dyskalemia, and absence of pericardial effusion on a transthoracic echocardiography done at bedside.Our hypothesis is an increase of the percentage of patients in sinus rhythm from 70 to 85% with landiolol in less than 48 h after onset of PoAF (alpha risk = 5%, power = 90%, bilateral test).DiscussionThe FAAC trial was approved by the Ethics Committee of EST III with approval number 19.05.08. The FAAC trial is the first randomized controlled trial comparing landiolol to amiodarone for PoAF after cardiac surgery. In case of higher rate of reduction with landiolol, this beta-blocker could be the drug of choice used in this context as to reduce the need for anticoagulant therapy and reduce the risk of complications of anticoagulant therapy for patients with a first episode of postoperative atrial fibrillation after cardiac surgery.Trial registrationClinicalTrials.gov NCT04223739. Registered on January 10, 2020.

Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization.

Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028). The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.

A Covid 19 Case Report complicated with respiratory failure and retroperitoneal hematoma

Introduction: The Covid 19 pandemic confronted us with a series of multidisciplinary pathologies, beginning with the virus and followed by a cascade of SIRS and multiorgan failure. During the treatment therapy of antivirals, anticoagulants, corticosteroids and antibiotics, we also encounter medications’ interactions. Method: We described a case report of a 74-year-old man, who during the course of hospitalization had several complications. Results: He developed respiratory failure, delirium, SIRS, as well as retroperitoneal hematoma (HRP) as a complication of anticoagulant therapy. It was followed by hemorrhagic shock, respiratory distress and the patient was submitted under mechanical ventilation with step-by-step resuscitation. The patient made clinical and laboratory improvement by being extubated and thereafter was rehabilitated pulmonary and physically. On the 42nd day of hospitalization the patient was discharged from the hospital. Pulmonary and locomotor rehabilitation of the patient was established 2-3 weeks after hospital discharge. Conclusion: Establishing a retroperitoneal hematoma diagnosis requires clinical intuition. Some signs which can raise an alert for a retroperitoneal hematoma can be hypotension, tachypnea and back and abdominal pain in patients who are under anticoagulant therapy. Key Words: Covid 19, complications, retroperitoneal hematoma.

Warfarin Related Kidney Damage: A Confusing Case of Thrombophlebitis Masquerading as Infection.

Anticoagulant-related nephropathy (ARN) is a rare, newly recognized cause of acute kidney injury and significant but underdiagnosed complication of anticoagulation therapy. ARN occurs in patients taking oral anticoagulant therapy most often warfarin or a novel oral anticoagulant (NOAC). It is a potentially devastating disorder with serious renal consequences and increased all-cause mortality. Anticoagulant-related nephropathy presents as an acute kidney injury (AKI) in the setting of a supratherapeutic INR with profuse glomerular hemorrhage seen as renal tubules filled with red cells and red cell casts on renal biopsy. Being that millions of Americans are on warfarin, a thorough understanding and awareness of the clinical presentation, diagnosis, and therapeutic interventions are crucial to protecting the renal function, lowering all-cause mortality and optimizing treatment. Our goal is to provide education on a newly recognized form of AKI and significant but underdiagnosed complication of anticoagulation therapy.

Bilateral Sub-acute Subdural Hematoma of the Posterior Fossa As a Complication of Anti-coagulation Therapy: A Case Report and Literature Review

Background: Subdural hematomas are one of the commonest neurosurgical pathologies faced in practice and it is rarely located in the posterior fossa. Posterior fossa subdural hematomas are challenging because of the difficulty in their diagnosis and management.
 Case Presentation: A case of bilateral sub-acute subdural hematoma of the posterior fossa in a 65-year-old female presented with a complaint of headache and vomiting for three weeks followed by a decreased level of consciousness two days prior to admission. The patient is a known cardiac patient on long-term anti-coagulant, her condition was intensively investigated and the diagnosis of posterior fossa subacute hematoma was reached, following which the patient was treated surgically and improved in the postoperative period.
 Conclusion: Subdural hematomas located in posterior fossa are considered very rare. Most of the reported cases are due to anti-coagulant use, with minor number of cases due to trauma. Literature denoted difficulty reaching diagnosis using only computed tomography and advice to be aided by magnetic resonance imaging as in our case. In most occasions, surgical management is the best choice for the management of such a case, regardless of surgical technique, and will result in excellent outcome.

Rosendaal linear interpolation method appraising of time in therapeutic range in patients with 12-week follow-up interval after mechanical heart valve replacement.

BackgroundThe objective of this study was to evaluate the quality of anticoagulation by the time in therapeutic range (TTR) for patients with 12-week INR follow-up interval.Materials and methodsFrom January 2018 to December 2020, a selective group of patients who underwent mechanical valve replacement and followed up at our anticoagulation clinic for adjustment of warfarin dose were enrolled. The incidences of complications of anticoagulation therapy were reported by linearized rates. TTR was calculated by the Rosendaal linear interpolation method.ResultsTwo hundred and seventy-four patients were eligible for this study. The mean age of these patients was 52.8 ± 12.7 years, and 65.7% (180 cases) of them were females. The mean duration of warfarin therapy was 16.7 ± 28.1 months. A total of 1309 INR values were collected, representing 66789 patient days. In this study, the mean TTR was 63.7% ± 18.6%, weekly doses of warfarin were 20.6 ± 6.0 mg/weekly, and the mean monitoring interval for the patient was 53.6 ± 27.1 days. There were 153 cases in good TTR group (TTR ≥ 60%) and 121 cases in poor TTR group (TTR < 60%). The calculated mean TTR in both groups was 42.6% ± 22.1% and 74.8% ± 10.4%, respectively. Compared with the TTR ≥ 60% group, the TTR < 60% group exhibited a more prevalence of female gender (p = 0.001), atrial fibrillation (p < 0.001), NYHA ≥ III (p < 0.001), and lower preoperative left ventricular ejection fraction (LVEF, p = 0.032). In multivariate analysis, female gender (p = 0.023) and atrial fibrillation (p = 0.011) were associated with TTR < 60%. The incidence of major bleeding and thromboembolic events was 2.7% and 1.1% patient-years, respectively. There was one death which resulted from cerebral hemorrhage. The incidence of death was 0.5% patient-years. The difference in anticoagulation-related complications between the TTR < 60% group and the TTR ≥ 60% group was not statistically significant.ConclusionFor patients with stable international normalized ratio monitoring results who are follow-up at anticoagulation clinics, a 12-week monitoring interval has an acceptable quality of anticoagulation. The female gender and atrial fibrillation were associated with TTR < 60%.

Warfarin-induced spontaneous intramural small bowel hematoma presenting as an acute abdomen: A case report

Rationale:Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen.Patient concerns:A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years.Diagnosis:Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen.Interventions:We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH.Outcomes:The patient had an uneventful recovery and was discharged in a relatively stable condition.Lessons:Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.

Target therapy for venous thrombosis: experimental extravagance or tangible future?

Anticoagulant therapy is considered to be a treatment and prophylaxis standard for venous thrombosis (VT). Despite the high efficacy and safety of modern anticoagulants, bleeding as the side effect remains a prominent unresolved problem that can limit their use. As interrelation between immune system and coagulation is the basis of immunothrombosis, immunosuppression could be considered an alternative in the target therapy for venous thrombosis. Endothelial activation due to the blood stasis and vein wall hypoxia together with proinflammatory mediators promote essential conditions for venous thrombosis. The key points of this process are also the platelets and leukocytes activation and neutrophil extracellular traps secretion. Inhibition of intercellular interactions by the adhesion and signal molecules deletion (P-selectins, galectins, HMGB1) can fully prevent thrombosis or significantly reduce the thrombus. The same effect is observed when platelets function is suppressed by GPIbα transformation, CLEC-2 deletion or von Willebrand factor deficiency. Neutropenia contributes to a change in the thrombus structure and density, and less often prevents its formation. In addition, one of the options for the VT prevention in the experiment is the introduction of resorption mediators, which are secreted by effector cells in the process of thrombosis resolution. Target therapy appears to be a promising method based on key links in the VT pathogenesis, which may allow avoiding typical complications of anticoagulant therapy.

Spontaneous retroperitoneal hematoma in COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has led to a global pandemic and unfortunately has caused a health crisis. Severe coronavirus disease 2019 (COVID-19) can manifest with bilateral pneumonia and hypoxemic respiratory failure but also can affect different organ systems. Spontaneous rectus sheath haematomas and retroperitoneal haematomas are recognized, rare, complications of anti-coagulation therapy, including LMWH. A prompt diagnosis is important to antagonize anticoagulation and prevent further bleeding. Massive bleeding into the retroperitoneum represents a problem not only because of the loss of intravascular volume, but also because the increase in abdominal pressure may compromise perfusion to different organs, such as the liver, gut, and kidneys. We present 3 cases of severe spontaneous soft tissue hematomas (SSTH) in patient with SARS-CoV-2 infection, who were taking low molecular weight heparin for prophylaxis of DIC and venous thromboembolism. First one is 56-yeard-old female patient with retroperitoneal and extraperitoneal haematoma presenting with dysuria and haematuria, the second one is 67-year-old male patient with iliopsoas haematoma and the third one is 51-year-old female patient with rectus sheath haematoma. All patients were treated conservatively. Clinicians should be attentive about bleeding complications as retroperitoneal haematomas in COVID-19 patients on anticoagulant therapy. There is no consensus on management of retroperitoneal haematomas. Each decision as conservative treatment, embolization or surgery should be made according to the clinical stability of the patient and by risk and benefit assessment.

Skin necrosis in COVID-19 patients: complication of therapy or one of clinical and pathological mechanisms of viral infection?

&lt;p&gt;The coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV). Dermatological disorders are among the numerous observations in COVID-19 patients that are consistently reported from various clinical sites throughout the world, although their relationship with illness severity is unknown. Urticarial rash, maculopapular or morbilliform rash, papulovesicular lesions, chilblain, livedo reticularis, vasculitis-like picture, and skin necrosis have all been reported with different frequencies and associated circumstances. In this review article, we will highlight reports of skin necrosis, one of the rare skin findings that are associated with COVID, and their clinical and pathophysiological aspects, in addition to attempting to determine whether they are one of the possible outcomes of this virus infection or a complication of various treatment programs. and to discuss the overlap between skin necrosis due to COVID-19-associated coagulopathies and disseminated intravascular coagulation. Cutaneous necrosis in COVID-19 patients during the pandemic period, according to this review, is not rare. possibly It is simple to diagnose and recognize this dermatological condition, but determining the causal variables and their function in pathogenesis is a complex and difficult task. It's also tough to categorize because it affects people of all ages, regardless of gender, ethnicity, or health status. All hypotheses discuss the direct viral role, the immune system's hyperinflammatory state with cytokine storm, the hypercoagulable state with vasculitis, anticoagulant therapy complications, and deep secondary necrotizing infections as possible interactions that lead to necrosis, which can result in serious outcomes such as disseminated intravascular coagulation if not properly treated.&lt;/p&gt;

Retroperitoneal Hematoma as a Complication of Anticoagulation Therapy with Heparin

Retroperitoneal Hematoma as a Complication of Anticoagulation Therapy with Heparin

Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism

BackgroundBleeding is the most dreaded complication of anticoagulant therapy for acute venous thromboembolism (VTE). Limited data exist about patient characteristics, time course and outcomes of major bleeding, according to the bleeding site. MethodsWe used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) registry (03/2001–07/2018) and identified patients who suffered from major bleeding during anticoagulation. We assessed patient characteristics, time course, and 30-day outcomes including mortality, re-bleeding, and VTE recurrences, according to bleeding site. ResultsAmong 78,136 patients with VTE receiving anticoagulation, 2244 (2.9%) suffered from major bleeding (gastrointestinal in 800, intracranial in 417, hematoma in 410, genitourinary in 222, retroperitoneal in 145; other sites in 250). There were variations in baseline characteristics, including older age (P < 0.001) and predominance of women (70.2% [95% confidence interval [CI]]: 65.6–74.6% versus 50.5%, 95% CI: 48.2–52.9, P < 0.001) in patients with hematoma, compared with other patients. Overall, 82.7% of hematomas and 81.4% of retroperitoneal bleeds occurred in the first 90 days after the diagnosis of the VTE event, compared with only 50.6% of intracranial bleeds. Across the bleeding subgroups, 30-day all-cause mortality rates were highest in patients who suffered from intracranial bleeding (41.0%; 99% confidence interval [CI]: 34.8–47.4%), and lowest in patients who suffered from hematoma (17.8%; 99% CI: 13.2–23.2%). Patients who suffered from a major bleeding event in the first 30 days after VTE had significantly higher odds at 90-day follow-up to develop mortality (including from bleeding), recurrent VTE, and recurrent major bleeding (all Ps < 0.001). Variations were observed in the results according to the bleeding site. ConclusionsMajor bleeding is a serious complication in VTE patients. Patient characteristics, time course and outcomes varied substantially according to the bleeding site. Additional studies are needed to tease out the impact of patient risk factors, treatment regimens, and a potential distinct effect from the site of bleeding. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT02832245 (RIETE registry).

COVID-19 İlişkili Antikoagülan Kullanımına Bağlı Hemorajiler: Üç Olgu Sunumu

In the pathogenesis of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, disseminated intravascular coagulation and venous thromboembolism are one of the causes of high morbidity and mortality. Therefore, anticoagulant drugs play an important role in treatment. One of the rare complications of anticoagulant therapy is bleeding in the retroperitoneal space. These hemorrhages require rapid diagnosis and an urgent approach. Retroperitoneal bleeding should be kept in mind among the many complications that develop in patients treated and followed-up due to coronavirus disease-2019 (COVID-19). For this purpose, we present 3 cases who developed spontaneous retroperitoneal bleeding under the treatment of COVID-19 in this article.

Unveiling the Uncanny- Unusual Hemorrhagic Complications of Anticoagulant Therapy – Case Series

Unveiling the Uncanny- Unusual Hemorrhagic Complications of Anticoagulant Therapy – Case Series