Annales françaises de médecine d'urgence

, Volume 5, Issue 1, pp 9–15 | Cite as

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 ?

  • B. -I. Mewasing
  • J. Pernet
  • C. Gast
  • P. -A. Raynal
  • Y. Yordanov
  • D. Pateron
  • P. Ray
Article Original / Original Article

Résumé

Introduction

Les accidents hémorragiques liés aux antivitamines K (AVK) sont une cause majeure de morbimortalité, et représente en France la première cause d’hospitalisations pour accidents iatrogènes graves. L’objectif de notre travail était d’évaluer la prise en charge des patients traités par du concentré de complexes prothrombiniques (CCP) pour une hémorragie grave liée aux AVK, au cours du temps, en particulier après la publication des recommandations de 2008.

Patients et méthode

Il s’agit d’une étude bicentrique, observationnelle et rétrospective. Les patients, ayant consulté en 2006, 2009 et 2012 au service d’accueil des urgences pour une hémorragie grave aux AVK, pour lesquels une réversion par du CCP a été administrée (prescriptions centralisées issues de la pharmacie), ont été inclus. Les patients, n’ayant pas reçu de CCP, n’ont pas été inclus.

Résultats

Cinquante-huit patients au total ont répondu aux critères d’inclusion. L’âge moyen était de 77 ans. La première cause d’anticoagulation orale était la fibrillation auriculaire. Les principaux sites de saignement étaient digestif (37 %) et cérébral (19 %). Le délai moyen d’attente de prise en charge médicale initiale était comparable au cours des trois années. Le temps de prescription du CCP était estimé à 146 minutes en moyenne sans modification au fil des années (138 en 2006, 131 en 2009 et 169 en 2012). La vitamine K a été administrée de manière identique au CCP (43 % en 2006, 80 % en 2009 et 68 % en 2012).

Conclusion

Nos résultats ne montrent pas d’amélioration de la prise en charge de ces patients au cours du temps, malgré les recommandations.

Mots clés

Accident hémorragique Antivitamine K Urgence Hémorragie intracrânienne Stratégie thérapeutique 

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, 131 in 2009 and 169 in 2012). Vitamin K was administered 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.

Keywords

Bleeding VKA Emergency Intracanial bleeding Therapeutic strategies 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2015

Authors and Affiliations

  • B. -I. Mewasing
    • 1
  • J. Pernet
    • 1
  • C. Gast
    • 1
  • P. -A. Raynal
    • 2
  • Y. Yordanov
    • 2
  • D. Pateron
    • 2
    • 3
  • P. Ray
    • 1
    • 3
    • 4
  1. 1.Service d’accueil des urgenceshôpital TenonParisFrance
  2. 2.Service d’accueil des urgenceshôpital Saint AntoineParisFrance
  3. 3.Sorbonne Universités UMPC Université Paris 06ParisFrance
  4. 4.DHU FAST, GH Pitie-Salpêtrière-Charles Foix, AP-HPParisFrance

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