Document Type

Conference Proceeding

Publication Date


Publication Title

Academic Emergency Medicine


Background: The Safety of Oral Anticoagulants Registry (SOAR) aims to describe the diversity in presentation and treatment strategies in patients with oral anticoagulant (OAC)-related acute hemorrhage (AH) or bleeding concern (BC; defined as OAC-driven treatment for, or delay to, a procedure, or prolonged observation) presenting to the emergency department. In this secondary analysis we report on patients receiving reversal or clotting factor repletion therapy. Methods: SOAR is a prospective, observational study of OAC-treated patients presenting with AH or BC requiring acute intervention. 31 US hospitals participated. Results: Of 1513 patients enrolled, the OAC was warfarin in 37.3% or a direct OAC (DOAC) in 63% (13% dabigatran, 50% FXa inhibitors). Mean age was 71.1 years and 53% were male. The most common indications for OAC were atrial fibrillation (AF) and venous thromboembolism, but other indications included prosthetic heart valve, heart failure, post-MI, and post-stroke not AF-related. Overall, 78% had AH (19% of which were life-threatening) and 22% had BC; 42% required red blood cell transfusion. Mortality was higher for AH (7.3%) than for BC (5.5%), but length of stay (4.5+/-7.4 for AH and 4.1+/-6.6 days for BC [median+/-SD]) were similar. Factor repletion with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), a single factor, or a combination of these was given to 42% of AH and 28% of BC patients. In patients on dabigatran, the specific reversal agent idarucizumab was given in 57% of AH (9% also received FFP and 3% PCC) and 43% of BC (2% also received FFP; none received PCC). Four anti-FXa-treated patients with AH were treated with andexanet alfa, which became available shortly before the conclusion of enrollment. Meanwhile, factor repletion was administered to 43% of AH patients on apixaban or rivaroxaban. In patients on warfarin, 23% of AH and 20% of BC did not receive vitamin K, while, in contrast, vitamin K was given to 9% and 7% of dabigatran and anti-FXa patients with AH, respectively, and to 12% of anti-FXa-treated patients with BC. Conclusion: Emergency physicians commonly treat anticoagulated patients with factor repletion or specific reversal agents when faced with AH or BC. Vitamin K is not completely utilized in warfarin-treated patients and is used unnecessarily in DOAC-treated patients.





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Society for Academic Emergency Medicine. SAEM Annual Meeting. May 14-17, 2019. Las Vegas NV. Meeting Abstract: 416