Management and outcome of major bleeding in patients receiving vitamin K antagonists for venous thromboembolism

Thromb Res. 2018 Nov;171:74-80. doi: 10.1016/j.thromres.2018.09.049. Epub 2018 Sep 22.

Abstract

Background: The optimal management of major bleeding in patients receiving vitamin K antagonists (VKA) for venous thromboembolism (VTE) is unclear.

Methods: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to assess the management and 30-day outcomes after major bleeding in patients receiving VKA for VTE.

Results: From January 2013 to December 2017, 267 of 18,416 patients (1.4%) receiving long-term VKA for VTE had a major bleeding (in the gastrointestinal tract 78, intracranial 72, hematoma 50, genitourinary 20, other 47). Overall, 151 patients (57%) received blood transfusion; 110 (41%) vitamin K; 37 (14%) fresh frozen plasma; 29 (11%) pro-haemostatic agents and 20 (7.5%) a vena cava filter. During the first 30 days, 59 patients (22%) died (41 died of bleeding) and 13 (4.9%) had a thrombosis. On multivariable analysis, patients with intracranial bleeding (hazard ratio [HR]: 4.58; 95%CI: 2.40-8.72) and those with renal insufficiency at baseline (HR: 2.73; 95%CI: 1.45-5.15) had an increased mortality risk, whereas those receiving vitamin K had a lower risk (HR: 0.47; 0.24-0.92). On the other hand, patients receiving fresh frozen plasma were at increased risk for thrombotic events (HR: 4.22; 95%CI: 1.25-14.3).

Conclusions: Major bleeding in VTE patients receiving VKA carries a high mortality rate. Intracranial bleeding and renal insufficiency increased the risk. Fresh frozen plasma seems to increase this risk for recurrent VTE.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Blood Transfusion / methods
  • Female
  • Hemorrhage / chemically induced*
  • Hemorrhage / mortality
  • Hemorrhage / therapy*
  • Hemostatics / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency / complications
  • Retrospective Studies
  • Treatment Outcome
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / drug therapy*
  • Vitamin K / antagonists & inhibitors*
  • Vitamin K / therapeutic use

Substances

  • Anticoagulants
  • Hemostatics
  • Vitamin K