Use of anticoagulation reversal therapy in the emergency department: a single-center real-life retrospective study

doi:10.5847/wjem.j.1920-8642.2023.004

World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (1): 56-58.doi: 10.5847/wjem.j.1920-8642.2023.004

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Use of anticoagulation reversal therapy in the emergency department: a single-center real-life retrospective study

Jacopo Davide Giamello¹^,²(), Andrea Pisano², Fabrizio Corsini², Remo Melchio³, Luca Bertolaccini⁴, Enrico Lupia⁵^,⁶, Giuseppe Lauria²

¹School of Emergency Medicine, University of Turin, Turin 10100, Italy
²Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo 12100, Italy
³Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo 12100, Italy
⁴Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan 20141, Italy
⁵Department of Emergency Medicine, Città della Salute e della Scienza Hospital, Turin 10126, Italy
⁶Department of Medical Sciences, University of Turin, Turin 10100, Italy

Received:2022-04-16 Accepted:2022-08-28 Online:2023-01-05 Published:2023-01-01
Contact: Jacopo Davide Giamello E-mail:jacopo.giamello@gmail.com

Abstract

Jacopo Davide Giamello, Andrea Pisano, Fabrizio Corsini, Remo Melchio, Luca Bertolaccini, Enrico Lupia, Giuseppe Lauria. Use of anticoagulation reversal therapy in the emergency department: a single-center real-life retrospective study[J]. World Journal of Emergency Medicine, 2023, 14(1): 56-58.

Figures/Tables 2

Table 1.

Baseline characteristics of patients

Demographic data	Values	Demographic data	Values
Age, years	82 (77, 86)	Interacting medications
Female	74 (39.4)	Amiodarone	12 (6.4)
Presentation		Clarithromycin	1 (0.5)
Respiratory rate, breaths/min	15 (14, 16)	Nothing	175 (93.1)
Oxygen saturation, %	97 (95, 99)	Events
Hearth rate, beats/min	80 (71, 91)	Trauma-associated major bleeding	66 (35.1)
Systolic blood pression, mmHg	140 (113, 160)	Spontaneous major bleeding	74 (39.4)
Diastolic blood pression, mmHg	80 (67, 90)	Need for urgent surgery/procedure	48 (25.5)
MAP, mmHg	96 (80, 110)	Bleeding site (n=140)
Temperature, ℃	36.2 (36.0, 36.6)	CNS	66 (47.1)
Glasgow Coma Scale <15	36 (19.1)	Upper GI	24 (17.1)
Oxygen-therapy at presentation	17 (9.0)	Lower GI	8 (5.7)
Comorbidities		Retroperitoneum	15 (10.7)
Smoking	31 (16.5)	Abdomen	4 (2.9)
Hypertension	150 (79.8)	Thorax	11 (7.9)
Chronic pulmonary disease	42 (22.3)	Limbs	6 (4.3)
Chronic heart disease	107 (56.9)	External	2 (1.4)
Chronic kidney disease	27 (14.4)	Urinary tract	3 (2.1)
Chronic liver disease	9 (4.8)	Pericardium	1 (0.8)
Diabetes	35 (18.6)	Reversal therapy
Active cancer	49 (26.1)	Three-factor prothrombin complex concentrate	103 (54.8)
Metastatic cancer	12 (6.4)	Four-factor prothrombin complex concentrate	59 (31.4)
Dementia	22 (11.7)	Idarucizumab	26 (13.8)
History of stroke	30 (16.0)	Laboratory test results
Peripheral vascular disease	43 (22.9)	Red blood cells, ×10¹²/L	4.11 (3.32, 4.53)
Previous bleeding event	17 (9.0)	Hemoglobin, g/dL	12.2 (10.0, 14.0)
Antiplatelet use	23 (12.2)	Hematocrit, %	37.00 (31.30, 41.75)
Atrial fibrillation/atrial flutter	158 (84.0)	Platelets, ×10⁹/L	201 (160, 250)
DVP/PE	33 (17.6)	RDW, %	14.8 (14.0, 15.9)
Charlson comorbidity index	6 (4, 7)	International normalized ratio (INR), s	2.35 (1.54, 3.17)
CHA2DS2-VASc score	4 (3, 5)	aPTT ratio	1.20 (1.05, 1.50)
HAS-BLED score	2 (2, 3)	Creatinine, mg/dL	0.99 (0.76, 1.70)
HAS-BLED ≥3	68 (36.2)	Outcomes
Anticoagulant therapy		48-hour mortality	15 (8.0)
Warfarin	100 (53.2)	30-day mortality	41 (21.8)
Direct oral anticoagulant	88 (46.8)	3-month mortality	60 (31.9)
Apixaban	25 (13.3)
Dabigatran	26 (13.8)
Edoxaban	10 (5.3)
Rivaroxaban	27 (14.4)

Table 1.

Table 2.

References 13

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Parameters	OR	95% CI	P-value
GCS at presentation	0.71	0.58-0.87	<0.001
Charlson comorbidity index	1.30	1.09-1.55	0.003
RDW	1.20	1.04-1.43	0.017

Use of anticoagulation reversal therapy in the emergency department: a single-center real-life retrospective study

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