Prevalence of Hemorrhagic Accidents with VKA in the Cardiology Department of Chu Aristide le Dantec. Retrospective study of 60 cases (2016-2020)

Introduction: Hemorrhagic events with VKA are among the leading causes of iatrogenic events and are potentially serious. They represent a major problem in the management of VKA overdose. The objective of this study was to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary profiles of VKA bleeding events. Methodology: This was a retrospective, descriptive, monocentric study over a four-year period from January 1, 2016, to December 31, 2020, in the cardiology department of the Aristide Le Dantec University Hospital. We included in our study all patients hospitalized for a bleeding event with proven VKA during the study period. Results: A total of 60 patients were hospitalized for VKA bleeding events. The mean age of the patients was 54.2 years (20 and 79 years). The patients were predominantly female, with a sex ratio of 0.54:1. Most patients (67%) lived outside Dakar. The mean HAS-BLED score was 4.6 with extremes of 3 and 7. The CHA2DS2-VASc score had a mean of 3.63, with extremes of 2 and 7. In biology, INRs were supra-therapeutic in all our patients, with a mean INR of 6.65. The lowest PT value was 3, while the highest value was 70, with a mean of 18.36. The most commonly used VKA molecule was acenocoumarol (93.3%), followed by fluindione (5%) and warfarin (1.7%). The duration of treatment varied widely, with extremes of 2 weeks and 10 years. We classified the hemorrhages according to their type and location, so 88.3% had external hemorrhage while 11.7% had internal hemorrhage. The most frequent type of hemorrhage was hemoptysis (38.3%), followed by epistaxis (25%), then externalized digestive hemorrhage (33.3%), gingivorrhage (11.7%), Haemorrhagic stroke (10%) and a thigh hematoma (1.7%). Therapeutically, all patients had received an INR check, discontinuation of VKAs and administration of vitamin K ampoules. Forty percent (40%) (n=24) received packed red blood cells. The evolution during hospitalization was favorable in 70% of cases. Complications included cardiovascular collapse in 3.3% (n=2). Hospital mortality was 26.7%. Conclusion: VKA bleeding events are frequent and have a significant iatrogenic effect. In our study, they were more frequent in women and elderly subjects, and more often related to bleeding risk factors and irregular follow-up. The management of these events requires control of risk factors and early treatment.