HEMORRHAGIC ACCIDENTS DURING PROLONGED AM BULATORY TREATMENT WITH ACENOCUMAROL

BACKGROUND: To analize hemorrhagic complications in a series of outpat ients treated with acenocumarol in an anticoagulant specialized unit b y a prospective observational clinical study. PATIENTS AND METHODS: 1, 200 outpatients (682 women/518 men, mean age 54.6 +/- 15.8 yrs.) treat ed with acenocumarol for at least 6 weeks, with a total follow-up of 2 ,795 patients-yr. Prevalence and incidence of bleeding was analyzed, T he episodes that were potentially life-threatening, or forced to blood transfusion or hospital patient admittance were considered as major b leedings, and the remainder episodes were minor. RESULTS: There were 3 79 minor bleedings in 258 patients (incidence 13.56/100 patients-yr.), 45 major bleedings (1.61/100 patients-yr.) and 2 lethal bleedings (0. 07/100 patients-yr.). Minor bleedings correlated with more advanced ag e (57.3 +/- 11.8 vs. 53.9 +/- 16.7 yrs., p = 0.002), with the first tw o months In treatment in the 511 patients who start the treatment duri ng the study (31.09 vs, 13.04/100 patients-yr., p < 0.001), and with a worse achievement of the desired anticoagulation (72.4% vs, 81.6%; p = 0.002), Major bleeding was associated with local causes in 48.9%, an d with an excessive anticoagulation in 35.6%. CONCLUSIONS: Bleeding is relatively frequent during acenocumarol therapy, mainly in patients w ith worse control, but only in a few of these episodes is severe, and is usually associated with local lesions.