Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2014

01-01-2014 | Original Article

Spontaneous and non-spontaneous bleeding complications in patients with oral vitamin K antagonist therapy

Authors: Martin Hoffmann, Markus Zimmermann, Rüdiger Meyer, Tilman Laubert, Nehara Begum, Tobias Keck, Peter Kujath, Erik Schloericke

Published in: Langenbeck's Archives of Surgery | Issue 1/2014

Login to get access

Abstract

Purpose

The aim of the study was to evaluate potential differences between patients with spontaneous and non-spontaneous bleeding episodes during treatment with vitamin K antagonists which mainly resulted in compartment syndromes.

Methods

The population in this study comprised 116 patients who suffered at least one bleeding complication which required surgical treatment during therapy with an oral vitamin K antagonist. The patients were treated between September 2001 and July 2008.

Results

Significant differences were observed between the two patient groups with regard to the presence of renal failure, arterial hypertension, and diabetes mellitus, which occurred more frequently in patients with spontaneous bleeding. Also, significantly more patients with spontaneous bleedings developed compartment syndrome that needed emergency operation. Overall mortality was 9.6 %, was associated with multiorgan failure in all patients, and was not different between the two patient groups.

Conclusions

The identification of high-risk patients before treatment with an oral vitamin K antagonist is of major importance. The existence of over-anticoagulation syndrome and compartment syndrome is associated with significant mortality and morbidity and should not be underestimated.
Literature
1.
Hirsh J, Dalen J, Anderson DR et al (2001) Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 119(1 Suppl):8S–21SPubMedCrossRef
2.
Harder S, Thurmann P (1996) Clinically important drug interactions with anticoagulants. An update. Clin Pharmacokinet 30(6):416–444PubMedCrossRef
3.
Visser LE, Bleumink GS, Trienekens PH et al (2004) The risk of overanticoagulation in patients with heart failure on coumarin anticoagulants. Br J Haematol 127:85–89PubMedCrossRef
4.
Schulman S, Beyth RJ, Kearon C, Levine MN; American College of Chest Physicians (2008) Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:257S–298SCrossRef
5.
Cannegieter SC, Rosendaal FR, Wintzen AR et al (1995) Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 333:11–17PubMedCrossRef
6.
Cadiou G, Varin R, Levesque H et al (2008) Risk factors of vitamin K antagonist overcoagulation. A case–control study in unselected patients referred to an emergency department. Thromb Haemost 100:685–692PubMed
7.
(1999) 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
8.
The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group (1997) A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. Ann Neurol 42:857–865CrossRef
9.
Ost D, Tepper J, Mihara H et al (2005) Duration of anticoagulation following venous thromboembolism: a meta-analysis. JAMA 294:706–715PubMedCrossRef
10.
Go AS, Hylek EM, Chang Y et al (2003) Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? JAMA 290:2685–2692PubMedCrossRef
11.
Palareti G, Leali N, Coccheri S et al (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian study on complications of oral anticoagulant therapy. Lancet 348:423–428PubMedCrossRef
12.
Breed WP, van Hooff JP, Haanen C (1969) A comparative study concerning the stability of the anticoagulant effect of acenocoumarol and phenprocoumon. Acta Med Scand 186:283–288PubMedCrossRef
13.
Thijssen HH, Hamulyak K, Willigers H (1988) 4-Hydroxycoumarin oral anticoagulants: pharmacokinetics-response relationship. Thromb Haemost 60:35–38PubMed
14.
Ariesen MJ, Tangelder MJ, Lawson JA et al.; Dutch Bypass Oral Anticoagulants on Aspirin Study Group (2005) Risk of major haemorrhage in patients after infrainguinal venous bypass surgery: therapeutic consequences? The Dutch BOA (Bypass Oral Anticoagulants or Aspirin) Study. Eur J Vasc Endovasc Surg 30:154–159
15.
Barth H, Stein H, Fasse A et al (1996) Intracerebral hemorrhage after systemic thrombolysis in patients with occlusion of the central retinal artery. Report of 2 cases. Ophthalmologe 93:739–744PubMedCrossRef
16.
Landefeld CS, Goldman L (1989) Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144–152PubMedCrossRef
17.
Launbjerg J, Egeblad H, Heaf J et al (1991) Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients. J Intern Med 229:351–355PubMedCrossRef
18.
Lundstrom T, Ryden L (1989) Haemorrhagic and thromboembolic complications in patients with atrial fibrillation on anticoagulant prophylaxis. J Intern Med 225:137–142PubMedCrossRef
19.
Petitti DB, Strom BL, Melmon KL (1986) Duration of warfarin anticoagulant therapy and the probabilities of recurrent thromboembolism and hemorrhage. Am J Med 81:255–259PubMedCrossRef
20.
Pollard JW, Hamilton MJ, Christensen NA et al (1962) Problems associated with long-term anticoagulant therapy. Observations in 139 cases. Circulation 25:311–317PubMedCrossRef
21.
Fihn SD, McDonell M, Martin D et al (1993) Risk factors for complications of chronic anticoagulation. A multicenter study. Warfarin Optimized Outpatient Follow-up Study Group. Ann Intern Med 118:511–520PubMedCrossRef
22.
Beyth RJ, Quinn LM, Landefeld CS (1998) Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med 105:91–99PubMedCrossRef
23.
White RH, McKittrick T, Takakuwa J et al (1996) Management and prognosis of life-threatening bleeding during warfarin therapy. National Consortium of Anticoagulation Clinics. Arch Intern Med 156:1197–1201PubMedCrossRef
24.
Vazquez E, Sanchez-Perales C, Garcia-Cortes MJ et al (2003) Ought dialysis patients with atrial fibrillation be treated with oral anticoagulants? Int J Cardiol 87:135–139PubMedCrossRef
25.
Stroke Prevention in Atrial Fibrillation Investigators (1996) Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet 348:633–638
26.
The European Atrial Fibrillation Trial Study Group (1996) Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 333:5–10
27.
White RH, Beyth RJ, Zhou H et al (1999) Major bleeding after hospitalization for deep-venous thrombosis. Am J Med 107:414–424PubMedCrossRef
28.
Levine MN, Raskob G, Beyth RJ et al (2004) Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:287S–310SPubMedCrossRef
29.
Haustein KO, Hüller G (1994) Pharmacokinetics of phenprocoumon. Int J Clin Pharmacol Ther 32(4):192–197PubMed
30.
31.
Hull R, Hirsh J, Jay R et al (1982) Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 307:1676–1681PubMedCrossRef
32.
Altman R, Rouvier J, Gurfinkel E et al (1991) Comparison of two levels of anticoagulant therapy in patients with substitute heart valves. J Thorac Cardiovasc Surg 101:427–431PubMed
33.
Saour JN, Sieck JO, Mamo LA et al (1990) Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med 322:428–432PubMedCrossRef
34.
Turpie AG, Gunstensen J, Hirsh J et al (1988) Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet 1:1242–1245PubMedCrossRef
35.
Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120:897–902PubMedCrossRef
36.
Winkes MB, Hoogeveen AR, Houterman S, Giesberts A, Wijn PF, Scheltinga MR (2012) Compartment pressure curves predict surgical outcome in chronic deep posterior compartment syndrome. Am J Sports Med 40(8):1899–1905PubMedCrossRef
37.
Iribarne A, Easterwood R, Yang J, Dayal R, Argenziano M (2010) Retroperitoneal hematoma with abdominal compartment syndrome during minimally invasive mitral valve replacement. Ann Thorac Surg 89(4):e17–e18PubMedCrossRef
38.
Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE, Fletcher JJ (2013) Management of intracranial hemorrhage in patients with left ventricular assist devices. J Neurosurg 118(5):1063–1068PubMedCrossRef
39.
Cheng J, Vemula N, Gendler S (2008) Small bowel obstruction caused by intramural hemorrhage secondary to anticoagulant therapy. Acta Gastroenterol Belg 71(3):342–344PubMed
40.
Hill H, Deppe H, Huchzermeyer H, Dormann AJ (2005) Duodenal ileus due to an intramural duodenal haematoma. Conservative therapy using a multiple lumen intestinal probe. Dtsch Med Wochenschr 130(3):92–94PubMedCrossRef
41.
Spinelli G, Damiano G, Palumbo VD, Sammartano A, Maione C, Marrazzo A, Bellavia M, Barone R, Buscemi G, Lo Monte AI (2012) Ileus following spontaneous jejunum intramural hematoma: case report and review of the literature. Acta Clin Croat 51(3):435–439PubMed
42.
Olson SA, Glasgow RR (2005) Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg 13(7):436–444PubMed
43.
Gourgiotis S, Villias C, Germanos S et al (2007) Acute limb compartment syndrome: a review. J Surg Educ 64(3):178–186PubMedCrossRef
44.
45.
Koestler W, Strohm PC, Suedkamp NP (2004) Acute compartment syndrome of the limb. Injury 35(12):1221–1227CrossRef
46.
De Laet IE, Ravyts M, Vidts W et al (2008) Current insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open! Langenbecks Arch Surg 393(6):833–847PubMedCrossRef
47.
Grottke O, Frietsch T, Maas M, Lier H, Rossaint R; German Society of Anaesthesiology and Intensive Care Medicine (2013) Dealing with massive bleeding and associated perioperative coagulopathy: recommendations for action of the German Society of Anaesthesiology and Intensive Care Medicine. Anaesthesist 62(3):213–216, 218–220CrossRef
48.
Seghatchian J, Samama MM (2012) Massive transfusion: an overview of the main characteristics and potential risks associated with substances used for correction of a coagulopathy. Transfus Apher Sci 47(2):235–243PubMedCrossRef
49.
Metadata
Title
Spontaneous and non-spontaneous bleeding complications in patients with oral vitamin K antagonist therapy
Authors
Martin Hoffmann
Markus Zimmermann
Rüdiger Meyer
Tilman Laubert
Nehara Begum
Tobias Keck
Peter Kujath
Erik Schloericke
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 1/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-013-1149-3

Other articles of this Issue 1/2014

Langenbeck's Archives of Surgery 1/2014 Go to the issue

Original Article

Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences

Review Article

Clinical review: surgical management of locally advanced and recurrent colorectal cancer

Review Article

Surgical treatment of peritoneal carcinomatosis: current treatment modalities

Original Article

Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996–2010). A population cross-sectional survey study

Original Article

Predictors of malignancy in primary aldosteronism

Rapid Communication

Technical feasibility of liver transplantation without cold storage