Contributions
Abstract: P21
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background/aim
Intracranial bleeding (IB) is a major cause of death and results from a wide spectrum of disorders. Although acquired coagulation alterations derived from antithrombotic therapy is one of the leading causes, other bleeding disorders could also contribute to this entity. Our aim was to describe the clinical profile, etiology and management in patients diagnosed with IB in a tertiary hospital.
Methods
A retrospective analysis was performed of a consecutive patient series, 18 years and above, with an IB diagnosis in our center from the 1st of January to 30th of June 2015. We studied demographic characteristics, clinical presentation, etiology, treatment strategies and outcome.
Results
A total of 213 patients were included in the statistical analysis; out of which, 122 cases (57%) were male and median age at presentation was 72 (29-96). The most frequent localization was intraparenchymal (35.6%), followed by subdural (30.9%) and subarachnoid (24.4%). Almost all patients were diagnosed by CT. Initial clinical presentation was heterogeneous, headache being the most common finding in the subarachnoid cohort, loss of consciousness in subdural cases and focal neurological signs in the intraparenchymal subgroup. Only an 11% had previous history of bleeding. Additionally, less than half (46%) received antithrombotic treatment, of which 38% were with acetylsalicylic acid 100 mg (ASA), 34% with a vitamin K antagonist (two-thirds of which were within therapeutic range) and 5% with DOACs. Primary prevention was the reason for 25% of the patients treated with ASA. We would like to highlight that 28% of these patients received antithrombotic reversal agents. With regards to the etiology, 35% was due to head trauma, 10% of aneurysm or vascular malformation, 29% of unknown cause and 7% due to antithrombotic therapy without previous trauma. Initial blood workup was altered without cause in 4.7% of patients, showing thrombopenia and elongated PT and aPTT. Although further studies were not conducted to determine the etiology of these findings. There was a 23% mortality of the cases studied.
Conclusion
In our cohort IB occurs mostly in head trauma injuries. Although almost half of them were on antithrombotic treatment, only some cases received reversal agents. Idiopathic haemorrhagic events and those with basic altered coagulation testing were not referred for further bleeding disorder advisement, bringing about the question of whether it’s worth testing for causes of congenital or acquired bleeding diathesis.
Abstract: P21
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background/aim
Intracranial bleeding (IB) is a major cause of death and results from a wide spectrum of disorders. Although acquired coagulation alterations derived from antithrombotic therapy is one of the leading causes, other bleeding disorders could also contribute to this entity. Our aim was to describe the clinical profile, etiology and management in patients diagnosed with IB in a tertiary hospital.
Methods
A retrospective analysis was performed of a consecutive patient series, 18 years and above, with an IB diagnosis in our center from the 1st of January to 30th of June 2015. We studied demographic characteristics, clinical presentation, etiology, treatment strategies and outcome.
Results
A total of 213 patients were included in the statistical analysis; out of which, 122 cases (57%) were male and median age at presentation was 72 (29-96). The most frequent localization was intraparenchymal (35.6%), followed by subdural (30.9%) and subarachnoid (24.4%). Almost all patients were diagnosed by CT. Initial clinical presentation was heterogeneous, headache being the most common finding in the subarachnoid cohort, loss of consciousness in subdural cases and focal neurological signs in the intraparenchymal subgroup. Only an 11% had previous history of bleeding. Additionally, less than half (46%) received antithrombotic treatment, of which 38% were with acetylsalicylic acid 100 mg (ASA), 34% with a vitamin K antagonist (two-thirds of which were within therapeutic range) and 5% with DOACs. Primary prevention was the reason for 25% of the patients treated with ASA. We would like to highlight that 28% of these patients received antithrombotic reversal agents. With regards to the etiology, 35% was due to head trauma, 10% of aneurysm or vascular malformation, 29% of unknown cause and 7% due to antithrombotic therapy without previous trauma. Initial blood workup was altered without cause in 4.7% of patients, showing thrombopenia and elongated PT and aPTT. Although further studies were not conducted to determine the etiology of these findings. There was a 23% mortality of the cases studied.
Conclusion
In our cohort IB occurs mostly in head trauma injuries. Although almost half of them were on antithrombotic treatment, only some cases received reversal agents. Idiopathic haemorrhagic events and those with basic altered coagulation testing were not referred for further bleeding disorder advisement, bringing about the question of whether it’s worth testing for causes of congenital or acquired bleeding diathesis.