Impaired kidney function at ED admission: a comparison of bleeding complications of patients with different oral anticoagulants

Martin Müller; Michaela Traschitzger; Michael Nagler; Spyridon Arampatzis; Aristomenis K Exadaktylos; Thomas C Sauter

doi:10.1186/s12873-021-00497-1

Impaired kidney function at ED admission: a comparison of bleeding complications of patients with different oral anticoagulants

BMC Emerg Med. 2021 Sep 18;21(1):105. doi: 10.1186/s12873-021-00497-1.

Authors

Martin Müller¹, Michaela Traschitzger¹, Michael Nagler², Spyridon Arampatzis³, Aristomenis K Exadaktylos¹, Thomas C Sauter⁴

Affiliations

¹ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland.
² University Institute of Clinical Chemistry, Inselspital Bern University Hospital, and University of Bern, Bern University, Bern, Switzerland.
³ Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland. thomas.sauter@insel.ch.

Abstract

Background: Up to a fourth of patients at emergency department (ED) presentation suffer from acute deterioration of renal function, which is an important risk factor for bleeding events in patients on oral anticoagulation therapy. We hypothesized that outcomes of patients, bleeding characteristics, therapy, and outcome differ between direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs).

Methods: All anticoagulated patients older than 17 years with an impaired kidney function treated for an acute haemorrhage in a large Swiss university ED from 01.06.2012 to 01.07.2017 were included in this retrospective cohort study. Patient, treatment, and bleeding characteristics as well as outcomes (length of stay ED, intensive care unit and in-hospital admission, ED resource consumption, in-hospital mortality) were compared between patients on DOAC or VKA anticoagulant.

Results: In total, 158 patients on DOAC and 419 patients on VKA with acute bleeding and impaired renal function were included. The renal function in patients on VKA was significantly worse compared to patients on DOAC (VKA: median 141 μmol/L vs. DOAC 132 μmol/L, p = 0.002). Patients on DOAC presented with a smaller number of intracranial bleeding compared to VKA (14.6% DOAC vs. 22.4% VKA, p = 0.036). DOAC patients needed more emergency endoscopies (15.8% DOAC vs, 9.1% VKA, p = 0.020) but less interventional emergency therapies to stop the bleeding (13.9% DOAC vs. 22.2% VKA, p = 0.027). Investigated outcomes did not differ significantly between the two groups.

Conclusions: DOAC patients were found to have a smaller proportional incidence of intracranial bleedings, needed more emergency endoscopies but less often interventional therapy compared to patients on VKA. Adapted treatment algorithms are a potential target to improve care in patients with DOAC.

Keywords: Anticoagulants; Bleeding; Direct oral anticoagulants; Kidney function; Vitamin-K antagonist.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Aged
Aged, 80 and over
Anticoagulants* / adverse effects
Emergency Service, Hospital
Female
Hemorrhage / diagnosis*
Humans
Kidney / physiopathology*
Kidney Function Tests
Male
Retrospective Studies
Vitamin K* / antagonists & inhibitors

Substances

Anticoagulants
Vitamin K