Research of antiaggregant and anticoagulant uses in patients presenting to the emergency department with nontraumatic bleeding

Introduction Drugs used by patients who admitted to Emergency Service due to haemorrhage have a great importance on management of these groups. In spite of there are many regional differences for haemorrhage, most commonly haemorrhage reason for patients who admitted to Emergency Service are gastrointestinal system and central nervous system haemorrhage. Using antiaggregant and anticoagulant drugs are an important risk factor in ethiology of haemorrhage. In our study, We researched for using antiaggregant-anticoagulant drugs; and additionaly the factor that effects in-hospital mortality and 30-day mortality in patients who admitted to emergency service with non-traumatic haemorrhage. Material method Patients aged 18 years and older, who admitted to Emergency Service of Dokuz Eylul University Hospital are included in this study. Patients demographic data (comorbid diseases, previous bleeding history, bleeding type, usage of antiaggregant and anticoagulant drugs, if used reason name of drugs) were recorded. Additionally vital, physical examination findings and laboratoary parameters ( hemogram, BUN, creatinin, coagulant parameters) were recorded. Treatments applied to the patients in the emergency service (transfusion of blood products, surgical intervention, medical treatment, endoscopy, colonoscopy, compression to the bleeding area, application of tampons, discontinuation of drugs and interventional procedures) were recorded in the study form, after that the outcomes of the patients after discharge from the emergency service were evaluated. On the 30th day of the admission to the emergency service, patients were contacted by phone to investigate about their survival. In order to evaluate the in-hospital survival, the information of the patients was accessed through the system and recorded. Major bleedings were defined as fatal bleeding, symptomatic bleeding in a critical organ or region(Intracranial, Intraspinal, retroperitoneal, intraarticular, pericardial, intra muscular bleeding with compartment syndrome), acute decline in hemoglobin value of 2 g/dL or more due to bleeding or as the need for 2 units of blood transfusion. Result 297 of 310 patients who applied with bleeding complaint between January – June 2021 were included in this study. The mean age of the patients were 62.2±18.9 in all population; 58.3±20.2 in women, 65.9±16.8 in men. When the comorbidities of the patients were analyzed, HT was the most common comorbidity. When comorbidities were evaluated as reason of antiaggregant and anticoagulant drug use, Coronary Artery Disease (28%) was shown to be the most common. The most common reason for admission was Gastrointestinal bleeding (48.1%); and menometrorrhagia(13.8%) was the second. The presence of any comorbidity was found to be significantly lower in patients admitted with menometrorrhagia compared to other bleeding types. As the number of antiaggregant agents taken increased, the risk of major bleeding risen significantly. The frequency of gastrointestinal bleeding was found to be significantly higher in NSAID users compared to other bleeding types. In-hospital mortality of patients with major bleeding was found to be 7.2 times higher than those without major bleeding. In addition, it was found that the 30-day mortality increased 4.5 times in patients who presented with Central Nervous System bleeding. Having hypertension comorbidity was also found to be another factor that increased the 30-day mortality 2.2 times. Discussion While antiaggregant-anticoagulant drugs were being used by more than half of the patients, antiaggregant-anticoagulant drugs and NSAIDs did not increase mortality or specific bleeding types, with the exception of an increase in the prevalence of GI bleeding with NSAIDs. The quantity of antiaggregants usage stands out as a significant factor in serious bleeding. While mortality of Central nervous system bleeding was high, having hypertension as a comorbidity had an important effect on mortality, too. The presence of Major bleeding had an impact on increasing in-hospital mortality and this situation must be considered during the hospitalization of these patients. Keywords: Emergency Service, haemorrhage, antiaggregant, anticoagulant