[How do we manage the hemorrhagic risk on hypovitaminosis K and treatments with antivitamin K].
Vitamin K deficiency leads to a deficit in vitamin K-dependent factors, resulting in either hypocoagulability and a decrease in the Quick one-stage prothrombin time expressed as the prothrombin time (PT), or in an increase in INR in patients receiving oral anticoagulation. The anesthesiologist's objective is to bring these values back into the safety range before surgery, i.e., above 50% for PT and below 1.5 for INR. The method to be used will be chosen according to the urgency of the correction. Safety ranges may be reached in 6-12 h following oral or parenteral administration of vitamin K. A 5-mg dose is usually sufficient. If the deficit in vitamin K-dependent factors requires immediate correction, intravenous administration of PPSB should be done. The minimum time during which antivitamin K treatment may be disrupted after surgery depends on both the possibility of restarting oral treatment and the risk of postoperative haemorrhage. During this period, the need for an anticoagulation treatment using heparin should be discussed according to the risk of thrombosis.
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Laboratoire d'hématologie, hôpital Purpan, Toulouse, France.
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003029:Coagulants / Q000494:pharmacology; D006801:Humans; D012307:Risk Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D014813:Vitamin K Deficiency / Q000150:complications*
D003029:Coagulants; D014812:Vitamin K