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Introduction Bleeding under oral anticoagulant is a frequent reason for consultation in the emergency department. The aim of our study was to compare thrombin generation (TG) parameters in 3 populations under oral anticoagulant: severe bleeding patients who received procoagulant factors, patients with non-severe bleeding without reversion and anticoagulated patients without bleeding events. Method We conducted a prospective, single-center study of TG in patients under oral anticoagulant (VKA, Direct Oral Anticoagulants (DOACs): rivaroxaban, dabigatran, apixaban). The study was performed on platelet-poor plasma collected on arrival (V1) before reversal therapy, then 30 min (V2), 6 h (V3) and 24 h (V4) after reversal. Results A total of 307 patients were included in this study with 98 severe bleeding reversed, 95 patients with clinical relevant bleeding but non-reversed and 108 patients without bleeding. For V1, VKA patients with reversed bleeding had a significant decrease in the main TG parameters compared to patients without bleeding (P = 0.017). Moreover at V1, the main parameters of TG were significantly decreased for VKA compared to DOACs (P Conclusion Patients on VKA regained a comparable coagulation state as healthy subjects after reversal therapy, whereas patients treated with DOACs and reversed with PCC or PCCa induced a hypercoagulable state. Probably, this hypercoagulable state could be minimized by reducing the doses of PCC or PCCa, or be circumvented by the use of specific antidotes. |
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