We reviewed retrospectively the medical records of all patients (n=77. mean age 74.2) on oral anticoagulants with an International normalized ratio (INR) of eight or above in a 12-month period in the Leicestershire District Health Authority (DHA).
From a total of 55 625 INRs, 131 (0.24%) were = 8. A major cause of over-anticoagulation was unsatisfactory dose loading during in-hospital commencement of oral anticoagulation.
The incidence of major bleeding was 1 2.9% of total episodes of INR = 8 X with two haemorrhage-related fatalities.
Therapy of major haemorrhage with fresh frozen plasma (FFP) and intravenous (i.v.) vitamin K proved effective but was not given in a majority of such cases.
In conclusion, improvements in initial dose loading of oral anticoagulation and in the management of major haemorrhage are required, Severely over-anticoagulated patients without obvious bleeding should nevertheless receive small dose vitamin K therapy to reduce the risk of haemorrhage related morbidity and mortality without compromising subsequent oral anticoagulant control.
Mots-clés Pascal : Anticoagulant, Antivitamine K, Chimiothérapie, Traitement, Voie orale, Surdosage, Hémorragie, Complication, Surveillance biologique, Audit, Epidémiologie, Royaume Uni, Europe, Incidence, Homme, INR
Mots-clés Pascal anglais : Anticoagulant, Antivitamin K, Chemotherapy, Treatment, Oral administration, Overdosing, Hemorrhage, Complication, Biological monitoring, Audit, Epidemiology, United Kingdom, Europe, Incidence, Human, INR
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0450769
Code Inist : 002B02G. Création : 25/01/1999.