Abstract Number: PB2068
Meeting: ISTH 2020 Congress
Background: Reports about Emergency Room (ER) access of patients on DOACs show that bleeding is a critical issue also in these patients.
Aims: To analyze reasons for ER access of patients on treatment with DOACs from 2014 to 2019, based on testing of DOACs´ plasma concentrations.
Methods: Based on test requests, we analyzed ER records for age, gender, type of DOAC, hour of admission to the ER, polypharmacy, reason for access, diagnosis, treatment and outcome. Time of last DOAC intake was only available for few patients.
Results: 975 patients (mean age 78±11 years, 47.9% women, 87.6% with NVAF) accessed the ER, increasing from 34 in 2014 to 406 in 2019. Dabigatran etexilate, apixaban, rivaroxaban and edoxaban were prescribed in 26%, 43%, 21%, and 10% of patients. Once-daily treatments were 1.73-fold more frequent in VTE patients (p=0.004), who were on average 10 years younger than NVAF patients (p< 0.00001). Bleeding was responsible for ER access in 36% of cases in 2014 and for 21% of cases in 2019, while incidence of embolism/thrombosis was 20% and 5%, respectively (p< 0.0005). Bleeding and embolic/thrombotic complications had similar frequency irrespective of gender (p=0.53) and DOAC (p=0.18). Patients' age was not different according to the reason for ER access (p=0.06). Intracerebral hemorrhage and gastrointestinal bleeding accounted for 20% and 41% of bleeding episodes. Co-administration of antiplatelet agents increased the bleeding risk (OR =2.16; 1.74-2.68 95%CI). In patients on twice-daily treatment, and with diagnoses other than bleeding or embolism/thrombosis, DOAC plasma concentrations showed a circadian pattern (nadir levels at 7.00-8.00 am and 8.00-9.00 pm). There was a trend for DOAC concentrations to be 25% lower in patients with embolism/thrombosis than in the remaining patients.
Conclusions: These data show that bleeding represents a major reason for ER access of patients on DOACs, especially for those who have co-administration of antiplatelet agents.
To cite this abstract in AMA style:Crippa L, Pozzi L, Tomassini L, Della Valle P, Pattarini E, Fattorini A, D'Angelo A. Emergency Room Access of Patients on DOACs: A Six Years Single Center Experience [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/emergency-room-access-of-patients-on-doacs-a-six-years-single-center-experience/. Accessed January 28, 2022.
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