• F Moustafa, L Poujol, N Vincent, J Saint-Denis, N Dublanchet, N Breuil, S Heuser, A Lebreton, F Dutheil, and J Schmidt.
• Service des urgences Adultes, CHU Clermont-Ferrand, Clermont-Ferrand (63), France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France. Electronic address: fmoustafa@chu-clermontferrand.fr.
• Am J Emerg Med. 2018 Jul 1; 36 (7): 1257-1261.

BackgroundAccording to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding.ObjectivesIn a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not.Materials And MethodsWe performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates.ResultsDuring the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5years (95% CI=72.6-78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0±4.6 vs. 4.1±3.0, p=0.002) and lower hemoglobin (8.1±1.8 vs. 11.9±2.2, p<0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding.ConclusionWe showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.Copyright © 2018 Elsevier Inc. All rights reserved.

27 keywords...

hide…