STUDY OBJECTIVE: To determine the outcome of over-anticoagulated patients who were treated with vitamin K and those who were treated conservatively by holding doses and increasing monitoring frequency. A secondary objective was to compare conservative management with American College of Chest Physicians (ACCP) treatment guidelines when followed. DESIGN: Retrospective chart review of all patients with international normalized ratios (INRs) of 6 or greater and concurrently receiving warfarin between November 1993 and February 1994. SETTING: A Veterans Affairs Medical Center providing inpatient and outpatient care. Patients receiving warfarin are managed by an established anticoagulation clinic. PATIENTS: Fifty-one consecutive patients receiving warfarin who had an INR of 6 or greater were reviewed. INTERVENTIONS: Data collection included INR, risks for bleeding, indication for anticoagulation, interventions, and patient outcomes. RESULTS: INRs ranged from 6.1 to 81.8. Forty-eight patients (94%) did not receive vitamin K; they were treated by withholding doses and increasing monitoring frequency. One developed minor bleeding. Three patients (6%) received vitamin K. Two of these patients died of unrelated problems. The third patient required 47 days of heparin therapy prior to achieving therapeutic oral anticoagulation. CONCLUSION: This trial showed that conservative treatment of nonbleeding overanticoagulated patients is safe. A prospective trial comparing the ACCP guidelines with a conservative approach is needed.
STUDY OBJECTIVE: To determine the outcome of over-anticoagulated patients who were treated with vitamin K and those who were treated conservatively by holding doses and increasing monitoring frequency. A secondary objective was to compare conservative management with American College of Chest Physicians (ACCP) treatment guidelines when followed. DESIGN: Retrospective chart review of all patients with international normalized ratios (INRs) of 6 or greater and concurrently receiving warfarin between November 1993 and February 1994. SETTING: A Veterans Affairs Medical Center providing inpatient and outpatient care. Patients receiving warfarin are managed by an established anticoagulation clinic. PATIENTS: Fifty-one consecutive patients receiving warfarin who had an INR of 6 or greater were reviewed. INTERVENTIONS: Data collection included INR, risks for bleeding, indication for anticoagulation, interventions, and patient outcomes. RESULTS: INRs ranged from 6.1 to 81.8. Forty-eight patients (94%) did not receive vitamin K; they were treated by withholding doses and increasing monitoring frequency. One developed minor bleeding. Three patients (6%) received vitamin K. Two of these patients died of unrelated problems. The third patient required 47 days of heparin therapy prior to achieving therapeutic oral anticoagulation. CONCLUSION: This trial showed that conservative treatment of nonbleeding overanticoagulated patients is safe. A prospective trial comparing the ACCP guidelines with a conservative approach is needed.
Authors: Nita A Limdi; Thomas D Nolin; Sarah L Booth; Amanda Centi; Marisa B Marques; Michael R Crowley; Michael Allon; T Mark Beasley Journal: Am J Kidney Dis Date: 2014-11-25 Impact factor: 8.860