Antithrombotic therapy in the etiology of an acute posthaemorrhagic anaemia

Česká verzia

Authors: I. Krč ¹; V. Krčová ²
Authors place of work: II. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jiří Ehrmann, CSc. ¹; Hemato-onkologická klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc. ²
Published in the journal: Vnitř Lék 2005; 91(7 a 8): 873-877
Category: 128th Internal Medicine Day - 21rd Vanysek's Day Brno 2005

Summary

In patients, undergoing for various reasons an antithrombotic therapy, severe, life-threatening bleeding can occur, mostly originating in upper parts of the gastrointestinal tract. From the viewpoint of internal medicine, this type of bleeding represents the most important cause of an acute posthaemorrhagic anaemia. Crucial factors influencing the fate of the patient appear to be both the magnitude of blood loss and the time interval from the outset of bleeding to the beginning of effective treatment. Although in approximately 80% of cases a spontaneous improvement of haemorrhagic manifestations can occur in 48 hours, this brings about a high lethality (10% according to the literature) irrespective of the use of modern therapeutic approaches, particularly in older patients. The aim of our prospective study was to evaluate a group of patients treated for acute massive gastrointestinal bleeding at the Intensive care unit of the II Medical Department of the Palacky University during a six-year period (1999-2005). Our cohort included a total of 1081 subjects (619 males and 462 females). Their past history confirmed a long term medication of different types of both antithrombotics and anticoagulants (34.0%), as well as a direct relationship to the bleeding episode. The most important inducing agent of haemorrhage was aspirin (17.9%), whilst warfarin caused bleeding in 9.5%. Important associated factors of the above complication were advanced age, alcohol abuse and polymedication, in particular simultaneous therapy of non-steroid antiinflammatory drugs. The most frequent sources of the haemorrhagic lesions were endoscopically confirmed peptic ulcers. A significant blood loss with heavy anaemia and values of haemoglobin below 100 gm/L was found in 49.2% of the patients in the examined group. Nevertheless, the four-week lethality was relatively low and equalled only 6.7%. Our survey has confirmed previous conclusions found in the literature, about an increased frequency of the acute massive gastrointestinal tract bleeding, caused by anticoagulation treatment. To prevent this complication it appears fundamental to monitor consistently all types of antithrombotic or anticoagulatory treatment, particularly in elderly subjects, alcohol abusers and polymedicated patients. Before prescription of long-term aspirin or other anticoagulants we should always consider and judge individually benefits of the chosen therapy against its possible side-effects.

Key words:
gastrointestinal tract bleeding - side-effects of antithrombotic therapy - acute posthaemorrhagic anaemia

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