Evaluation of the Impact of an Expert Opinion During the Management of Patients With Severe Bleeding on Oral Anticoagulants. (BANET)

Evaluation of the Impact of an Expert Opinion During the Management of Patients With Severe Bleeding on Oral Anticoagulants.

Evaluation of the Impact of an Expert Opinion During the Management of Patients With Severe Bleeding on Oral Anticoagulants.

The goal of this randomized clinical trial is to evaluate the impact of an expert opinion during the management of patients with severe bleeding on oral anticoagulants. The main question it aims to answer is : • Does an expert help of decision during the management of patients with severe bleeding is superior to classic management ? The centers will be randomized in one of the two groups : control group and interventional group. Patients will be followed for 3 months. At their inclusion they will be managed in conformity of the randomisation of their center. They will be followed at hour 0 + 6 , H0+24 and at the end of hospitalization. After 3 months, they will be called to assess the occurrence of thrombotic events ou hemorrhage complications. Researchers will compare the classic management versus the management with an expert opinion to see if the expert opinion is superior to classic management.

Centers will be randomized in two arms : control group : each center will manage hemorrhage of participation as they usually did interventional group : management of hemorrhage will be guided by the expert team

The effectiveness of the management of bleeding will be evaluated with a rate of compliance with the recommendations in the event of major bleeding under oral anticoagulants

Major thrombosis including symptomatic proximal venous thrombosis, symptomatic or non-symptomatic pulmonary embolism, ischemic vascular accident, myocardial infarction, cerebral thrombophlebitis, mesenteric portal thrombosis at 3 months

Rate of correction of haemostasis disorders at 6 hours post-reversion defined by an INR of less than 1.5 for Vitamin K Antagnist and normalization of activated partial thromboplastin time, prothrombin time, anti-Xa activity according to local normal values.

Comparison of the time between the arrival of the patient in the emergency room and the implementation of the reversal Comparison of the time between the patient's arrival in the emergency room and the performance of diagnostic imaging, particularly cerebral Comparison of the time between the patient's arrival in the emergency room and the performance of a haemostatic procedure (interventional radiology, surgery, fibroscopy)

Inclusion Criteria: Major patient treated with oral anticoagulants, admitted in an emergency department For suspected major bleeding defined according to the criteria of the International Society of Thrombosis and Haemostasis Able to give informed consent to participate in research or, in the event of an emergency, to take charge of a reference person Affiliated to a Social Security scheme. Exclusion Criteria: Pregnant or breastfeeding women Patient under guardianship, curatorship or safeguard of justice Administration within the last 24 hours of parenteral anticoagulant. Refusal to participate