Hospitalization and treatment analysis after vitamin K antagonists overdose

Aim of the study – to find risk factors for longer hospitalization and additional treatment for patients with vitamin K antagonist overdose and to describe how hospitalization length and treatment quantities change after bleeding occurs. Methods. Following information about patients with vitamin K antagonists (warfarin) overdose was analysed: bleeding risk factors, overdose outcomes, hospitalization length, bleeding treatment. Results. 116 (77,3%) patients with bleeding and 48 (43,5%) without bleeding needed additional treatment for bleeding and/or following complications. (p<0,001). Patients with bleeding event needed more red blood cell units (p<0,001), fresh frozen plasma units (p<0,001), vitamin K (p=0,03). These differences are even bigger in group with major bleeding event (p<0,001). Previously diagnosed anaemia is a risk factor for additional treatment need during hospitalization (p<0,001). Average hospitalization length was longer for patients with anaemia (p=0,05), thrombocytopenia (p=0,05) or liver disease history (p=0,04), hospitalization length was significantly longer for patients with bleeding event (p=0,003), 11,8±8,7 days and 9,1±4,6 days respectively. The average hospitalization length for patients with haemorrhagic stroke was 23,3±18,2 days. Conclusions. Vitamin K antagonists overdose requires additional treatment and longer hospitalization: average hospitalization length is 3 days longer after bleeding occurs, and red blood cell units consumption has grown 10 times over five year

Risk factors distribution in patients with symptomic vitamin K antagonist overdose

Aim of the study. To determine risk factors for bleeding, major bleeding and death in patients with overdose of vitamin K antagonists. Methods. The retrospective study examined patients, who have overdosed vitamin K antagonists and were admitted to Vilnius university Santariškės hospital between 2010-01-01and 2016- 10-31. Age, sex and bleeding risk factors were compared between groups with bleeding events and without bleeding events. Results. Total of 518 patients’ data were analysed, 253 (48,8%) were men, 265 (51,2%) women, average age was 73,2±11,2 years old. 298 (57,5%) had bleeding event, 149 (50%) were women, average age was 72,3±11,7 years old. Group with bleeding event were more likely to have gastrointestinal bleeding history:16 (5,4%) vs. 3 (1,4%) (p=0,017. 162 patients had major bleeding, average age was 72,8±11,8 years old, 88 (54,3%) were women. Major bleeding group also had more common gastrointestinal bleeding history - 10 (6,2%) vs. 9 (2,5%) (p=0,04). 56 (10,8% ) patients died, average age was 74,8±11,2 years old, 27 (48,2%) were women . Patients with lethal outcomes had kidney disease history more often (creatinine was over 200mmol/l) -17 (30,4%) vs. 64 (13,9%) (p=0,001). Conclusions. Patients who had symptomic warfarin overdose with bleeding or major bleeding were more likely to have gastrointestinal bleeding history. 9,4% of all bleeding event were lethal. Patients who died during hospitalization and had warfarin overdose were more likely to have kidney diseases and creatinine value over 200 mmol/l. These risk factors might be prognostic to predict if warfarin overdose will be symptomic, but futher investigation is required

Increase of Myocardial Ischemia Time and Short-Term Prognosis of Patients with Acute Myocardial Infarction during the First COVID-19 Pandemic Wave

Background and objectives: early reports showed a decrease in admission rates and an increase in mortality of patients with acute myocardial infarction (AMI) during the first wave of COVID-19 pandemic. We sought to investigate whether the COVID-19 pandemic and associated lockdown had an impact on the ischemia time and prognosis of patients suffering from AMI in the settings of low COVID-19 burden. Materials and Methods: we conducted a retrospective data analysis from a tertiary center in Lithuania of 818 patients with AMI. Data were collected from 1 March to 30 June in 2020 during the peri-lockdown period (2020 group; n = 278) and compared to the same period last year (2019 group; n = 326). The primary study endpoint was all-cause mortality during 3 months of follow-up. Secondary endpoints were heart failure severity (Killip class) on admission and ischemia time in patients with acute ST segment elevation myocardial infarction (STEMI). Results: there was a reduction of 14.7% in admission rate for acute myocardial infarction (AMI) during the peri-lockdown period. The 3-month mortality rate did not differ significantly (6.9% in 2020 vs. 10.5% in 2019, p = 0.341 for STEMI patients; 5.3% in 2020 vs. 2.6% in 2019, p = 0.374 for patients with acute myocardial infarction without ST segment elevation (NSTEMI)). More STEMI patients presented with Killip IV class in 2019 (13.5% vs. 5.5%, p = 0.043, respectively). There was an increase of door-to-PCI time (54.0 [42.0&ndash;86.0] in 2019; 63.5 [48.3&ndash;97.5] in 2020, p = 0.018) and first medical contact (FMC)-to-PCI time (101.0 [82.5&ndash;120.8] in 2019; 115 [97.0&ndash;154.5] in 2020, p = 0.01) during the pandemic period. Conclusions: There was a 14.7% reduction of admissions for AMI during the first wave of COVID-19. FMC-to-PCI time increased during the peri-lockdown period, however, it did not translate into worse survival during follow-up