Skip to main content
Log in

Gestion des accidents des anticoagulants chez le sujet âgé en médecine d’urgence

Emergency management of complications of anticoagulant therapies in the elderly

  • Mise au Point / Update
  • Published:
Les cahiers de l'année gérontologique

Résumé

Des recommandations récentes françaises et nordaméricaines ont été proposées afin d’améliorer la prise en charge urgente des effets secondaires des anticoagulants, largement dominés par les hémorragies qui paraissent plus fréquentes chez les sujets âgés. La gestion de ces accidents des anticoagulants est résumée dans cet article en insistant sur les données épidémiologiques et thérapeutiques propres aux patients âgés et à la médecine d’urgence, quand elles existent.

Abstract

Recent recommendations to improve the urgent management of side effects of anticoagulant therapies have been published. They focus mainly on hemorrhagic complications, which are more common in the elderly. They are summarized in this article, focusing on epidemiologic and therapeutic data in emergency elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Références

  1. Singer DE, Albers GW, Dalen JE, et al (2008) Antithrombotic therapy in atrial fibrillation. Chest 133:546S–592S

    Article  PubMed  CAS  Google Scholar 

  2. Spencer FA, Gore JM, Lessard D, et al (2008) Venous thromboembolism in the elderly. A community-based perspective. Thromb Haemost 100:780–788

    PubMed  CAS  Google Scholar 

  3. Pouyanne P, Haramburu F, Imbs JL, et al (2000) Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. French Pharmacovigilance Centres. BMJ 320:1036

    Article  PubMed  CAS  Google Scholar 

  4. agmed.sante.gouv.fr (2008) Matinées avec la presse, Afssaps. EMIR: effets indésirables des médicaments: incidence et risque sur les hospitalisations liées à un effet indésirable médicamenteux. Coordination CRPV de Bordeaux

  5. Shehab N, Sperling LS, Kegler SR, Budnitz DS (2010) National Estimates of Emergency Department visits for hemorrhagerelated adverse events from clopidogrel plus aspirin and from warfarin. Arch Intern Med 170:1926–1933

    Article  PubMed  Google Scholar 

  6. Schulman S, Beyth RJ, Kearon C, Levine MN (2008) Hemorraghic complications of anticoagulant and thrombolytic treatment. Chest 133:257S–2598S

    Article  PubMed  CAS  Google Scholar 

  7. van Dongen CJJ, van der Belt AGM, Prins MH, et al (2004) Fixed dose subcutaneous low-molecular weight heparins vs adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev CD001100

  8. Campbell NR, Hull RD, Brant R, et al (1996) Aging and heparinrelated bleeding. Arch Intern Med 156:857–860

    Article  PubMed  CAS  Google Scholar 

  9. Siguret V, Pautas E, Gouin I (2004) Low-molecular weight heparin treatment in elderly subjects with or without renal insufficiency: new insights between June 2002 and March 2004. Curr Opin Pulm Med 10:366–370

    Article  PubMed  CAS  Google Scholar 

  10. Gouin-Thibault I, Pautas E, Siguret V (2005) Safety profile of different low-molecular weight heparins used at therapeutic dose. Drug Saf 28:333–349

    Article  PubMed  CAS  Google Scholar 

  11. Warkentin TE, Greinacher A, Koster A, Lincoff AM (2008) Treatment and prevention of heparin-induced thrombocytopenia. Chest 133:340S–380S

    Article  PubMed  CAS  Google Scholar 

  12. www.afssaps.fr (2009) Recommandations de bonne pratique. Prévention et traitement de la maladie thromboembolique veineuse en médecine. Agence française de sécurité sanitaire des produits de santé

  13. Ansell J, Hirsh J, Hylek E, et al (2008) Pharmacology and management of the vitamin K antagonists. Chest 133:160S–198S

    Article  PubMed  CAS  Google Scholar 

  14. Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 154:1449–1457

    Article  Google Scholar 

  15. Palareti G, Leali N, Coccheri S, et al (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort prospective collaborative study (ISCOAT). Lancet 348:423–428

    Article  PubMed  CAS  Google Scholar 

  16. Jackson SL, Peterson GM, Vial JH, et al (2001) Outcomes in the management of atrial fibrillation: clinical trials results apply in practice. Intern Med J 31:329–336

    Article  PubMed  CAS  Google Scholar 

  17. Evans A, Kalra L (2001) Are the results of randomized controlled trials on anticoagulation in patients with atrial fibrillation generalizable to clinical practice? Arch Intern Med 161:1443–1447

    Article  PubMed  CAS  Google Scholar 

  18. Go AS, Hylek EM, Chang Y, et al (2003) Anticoagulant therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? JAMA 290:2685–2692

    Article  PubMed  CAS  Google Scholar 

  19. Fang MC, Go AS, Chang Y, et al (2007) Death and disability from warfarin-associated intracranial and extracranial hemorrhages. Am J Med 120:700–705

    Article  PubMed  Google Scholar 

  20. Mina AA, Bair HA, Howells GA, Bendick PJ (2003) Complications of preinjury warfarin use in the trauma patient. J Trauma 54:842–847

    Article  PubMed  Google Scholar 

  21. Karni A, Holtzman R, Bas T, et al (2001) Traumatic head injury in the anticoagulated trauma patient: a lethal combination. Am Surg 67:1098–1100

    PubMed  CAS  Google Scholar 

  22. Ferrera PC, Bartfield JM (1999) Outcomes of anticoagulated trauma patients. Am J Emerg Med 17:154–156

    Article  PubMed  CAS  Google Scholar 

  23. Garra G, Nached AH, Capobianco L (1999) Minor head trauma in anticoagulated patients. Acad Emerg Med 6:21–24

    Article  Google Scholar 

  24. Wojcik R, Cipolle MD, Sisilove E, et al (2001) Preinjury warfarin does not impact outcome in trauma patients. J Trauma 51:1147–1152

    Article  PubMed  CAS  Google Scholar 

  25. Gangavati AS, Kiely DK, Kulchicki LK, et al (2009) Prevalence and characteristics of traumatic intracranial hemorrhage in elderly failers presenting to the emergency department without focal findings. J Am Geriatr Soc 57:1470–1474

    Article  PubMed  Google Scholar 

  26. Gage BF, Yan Y, Milligan PE, et al (2006) Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J 151:713–719

    Article  PubMed  Google Scholar 

  27. Shireman TI, Mahnken JD, Howard PA, et al (2006) Development of a contemporary bleeding risk model for elderly warfarin recipients. Chest 130:1390–1396

    Article  PubMed  Google Scholar 

  28. Hutten BA, Lensing AW, Kraijenhagen RA, Prins MH (1999) Safety of treatment with oral anticoagulants in the elderly. A systematic review. Drugs Aging 14:303–312

    Article  CAS  Google Scholar 

  29. Pautas E, Gouin-Thibault I, Debray M, et al (2006) Hemorrhagic complications of vitamin K antagonists in the elderly: risk factors and management. Drugs Aging 23:13–25

    Article  PubMed  CAS  Google Scholar 

  30. Hylek EM, Evans-Molina C, Shea C, et al (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115:2689–2696

    Article  PubMed  CAS  Google Scholar 

  31. Fang MC, Go AS, Hylek EM, et al (2006) Age and the risk of warfarin-associated hemorrhage: the anticoagulation and risk factors in atrial fibrillation study. J Am Geriatr Soc 54:1231–1236

    Article  PubMed  Google Scholar 

  32. Thompson HJ, McCormick WC, Kagan SH (2006) Traumatic brain injury in older adults: epidemiology, outcomes and future implications. J Am Geriatr Soc 54:1590–1595

    Article  PubMed  Google Scholar 

  33. Hylek EM, Go AS, Chang Y, et al (2003) Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 349:1019–1026

    Article  PubMed  CAS  Google Scholar 

  34. Reynolds MW, Fahrbach K, Hauch O, et al (2004) Warfarin anticoagulation and outcomes in patients with atrial fibrillation: a systematic review and meta-analysis. Chest 126:1938–1945

    Article  PubMed  Google Scholar 

  35. Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120: 897–902

    PubMed  CAS  Google Scholar 

  36. Fang MC, Chang Y, Hylek EM, et al (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141:745–752

    PubMed  Google Scholar 

  37. www.has-sante.fr (2008) Recommandations professionnelles. Prise en charge des surdosages en antivitamines K, des situations à risque hémorragique et des accidents hémorragiques chez les patients traités par antivitamines K en ville et en milieu hospitalier

  38. Dezee KJ, Shimeall WT, Douglas KM, et al (2006) Treatment of excessive anticoagulation with phytonadione (vitamin K): a metaanalysis. Arch Intern Med 166:391–397

    Article  PubMed  CAS  Google Scholar 

  39. van Geest-Daalderop JH, Hutten BA, Pequeriaux NC, et al (2007) Invasive procedures in the outpatient setting: managing the short-acting acenocoumarol and the long-acting phenprocoumon. Thromb Haemost 98:747–755

    PubMed  Google Scholar 

  40. Crowther MA, Julian J, McCarty D, et al (2000) Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomized trial. Lancet 356:1551–1553

    Article  PubMed  CAS  Google Scholar 

  41. Ageno W, Garcia D, Silingardi M, et al (2005) A randomized trial comparing 1 mg of oral vitamin K with no treatment in the management of warfarin-associated coagulopathy in patients with mechanical heart valves. J Am Coll Cardiol 46:730–742

    Article  Google Scholar 

  42. Hylek EM, Regan S, Go AS, et al (2001) Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med 135:393–400

    PubMed  CAS  Google Scholar 

  43. Siguret V, Esquirol C, Debray M, et al (2003) Surdosages en antivitamine K dans une population de patients hospitalisés âgés de plus de 70 ans. Presse Med 32:972–977

    PubMed  CAS  Google Scholar 

  44. Holbrook AM, Pereira JA, Labiris R, et al (2005) Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 165:1095–1106

    Article  PubMed  CAS  Google Scholar 

  45. Vigué B, Ract R, Tremey B, et al (2007) Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Med 33:721–725

    Article  PubMed  Google Scholar 

  46. Lubetsky A, Hoffman R, Zimlichman R (2004) Efficacy and safety of a prothrombin complex concentrate (Octaplex) for rapid reversal of oral anticoagulation. Thromb Res 113:371–378

    Article  PubMed  CAS  Google Scholar 

  47. Kessler CM (2006) Urgent reversal of warfarin with prothrombin complex concentrate: where are the evidence-based data? J Thromb Haemost 4:963–966

    Article  PubMed  CAS  Google Scholar 

  48. Pabinger I, Brenner L, Kalina U, et al (2008) Prothrombin complex concentrate (Beriplex P/N) for emergency anticogulation reversal. J Thromb Haemost 6:622–631

    Article  PubMed  CAS  Google Scholar 

  49. Lankiewicz MW, Hays J, Friedman KD (2006) Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost 4:967–970

    Article  PubMed  CAS  Google Scholar 

  50. Vigué B (2009) Bench-to-beside review: optmising emergency reversal of vitamin K antagonists in severe haemorrhage — from theory to practice. Crit Care 13:209

    Article  PubMed  Google Scholar 

  51. Lubetsky A, Yonath H, Olchovsky D, et al (2003) Comparison of oral vs intravenous phytonadione (vitamin K1) in patients with excessive anticoagulation: a prospective randomized controlled study. Arch Intern Med 163:2469–2473

    Article  PubMed  CAS  Google Scholar 

  52. Nishijima DK, Dager WE, Schrot RJ, Holmes JF (2010) The efficacy of factor VIIa in emergency department patients with warfarin use and traumatic intracranial hemorrhage. Acad Emerg Med 17:244–251

    Article  PubMed  Google Scholar 

  53. Tremey B, Tazarourte K, Ract C, et al (2009) Teaching improves adherence to clinical guidelines in the treatment of oral anticoagulation-related severe bleeding in the emergency department. Intensive Care Med 35:1444–1448

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Pautas.

About this article

Cite this article

Pautas, E., Peyron, I., Mitha, N. et al. Gestion des accidents des anticoagulants chez le sujet âgé en médecine d’urgence. cah. année gerontol. 3, 83–89 (2011). https://doi.org/10.1007/s12612-011-0182-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12612-011-0182-5

Mots clés

Keywords

Navigation