BLEEDING THE AVK STUDY WITNESS CASES: ABOUT 200 PATIENTS.

Hemorrhagic stroke is the most common and the most dreadful complication of the vitamin K antagonists. This work is a case control study, involving 200 patients under VKA, followed in cardiology consultation of the military hospital of Marrakech, spread over one year, from December 2013 to November 2014. The purpose of this work is to determine the epidemiology of bleeding with VKA, as well as highlight the characteristics of patients who have this serious complication. Among the 200 patients, 30 (15%) had a hemorrhagic stroke. The average age of these patients was 57.6 years with a sex ratio of 1, 14. The majority of cases had at least a bleeding risk factors ( age > 60 years : 46.6%, the biological overdose of INR 87% , drug interactions : 43% , hypertension 28%, serious heart disease: 14% , stroke : 20% , renal failure:17% , HAS- BLED score?3 : 23.33%). Valvular heart disease and valve replacement were the most common indications (42%), followed by atrial fibrillation (31%). The mean duration of treatment was 4.5 years. 46.5% were severe bleeding as classified by Levine. The gastro-intestinal tract represented the most frequent site of bleeding (23%). Poor adherence was the main cause of bleeding, found in 39% of cases. Our work could define some predictive risk factors of bleeding to be considered during monitoring of patients on VKA. Prevention remains the average capital to limit occurred of the complications.