Hemorrhagic Complications of Anticoagulant Therapy

TLDR

Anticoagulant therapy carries bleeding risks, especially in older patients, those with urologic or gynecologic conditions, postpartum women, or when started with large oral doses, and gastrointestinal or pelvic bleeding warrants careful investigation for underlying causes. In a cohort of 3,862 anticoagulant courses, bleeding occurred in 6.8% (263 events), including four hemorrhage‑related deaths, with higher rates linked to greater treatment intensity, and over half of bleeds had identifiable lesions, some only detected after bleeding onset.

Abstract

Bleeding was detected during 263 (6.8%) of 3,862 courses of anticoagulant treatment. Four deaths were attributed to anticoagulant-induced hemorrhage. The frequency of bleeding increased with the intensity of treatment as reflected in daily determinations of "prothrombin activity." Other epidemiologic factors possibly associated with an increased risk of bleeding included advanced age, urologic disorders, gynecologic problems, the postpartum state, and the initiation of therapy by administration of large oral doses of anticoagulant. More than one half of those who developed bleeding had an identifiable lesion that appeared to be responsible for the bleeding. In 32 patients, the responsible lesion was recognized only after bleeding had occurred. Anticoagulantinduced bleeding from the gastrointestinal tract or female pelvic organs warrants a thorough search for an underlying cause.