Coagulopathy and bleeding associated with salicylate toxicity

Area of Science:

• Toxicology
• Hematology

Background:

• Salicylate toxicity is a frequent cause of illness and hospitalization.
• Studies indicate salicylates inhibit clotting factor activation.
• Coagulopathy and major bleeding from salicylate toxicity are infrequently reported.

Purpose of the Study:

• To investigate the incidence and risk factors for coagulopathy and major bleeding in salicylate toxicity.
• To determine the clinical significance of bleeding complications in salicylate overdose.

Main Methods:

• Retrospective study of patients with serum salicylate > 30 mg/dL from 2001-2011.
• Defined coagulopathy as INR > 1.5.
• Defined major bleeding by specific criteria including mortality, site of bleeding, hemoglobin drop, or transfusion requirements.

Main Results:

• 12% of patients with elevated salicylate developed coagulopathy.
• 6% experienced major bleeding, and 3% died.
• Duration of elevated salicylate and renal impairment were linked to coagulopathy; no factors predicted major bleeding.

Conclusions:

• Coagulopathy and major bleeding are underrecognized complications of salicylate toxicity.
• Renal impairment and duration of salicylate exposure are risk factors for coagulopathy.
• Bleeding can occur without coagulopathy, suggesting other mechanisms like platelet dysfunction may be involved.