Audit of patients on oral anticoagulants with International normalized ratios of eight or above.
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 > or = 8. A major cause of over-anticoagulation was unsatisfactory dose loading during in-hospital commencement of oral anticoagulation. The incidence of major bleeding was 12.9% of total episodes of INR > or = 8 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 anti-coagulant control.
Murphy
P T
PT
Department of Haematology, Leicester Royal Infirmary, UK.
Casey
M C
MC
Abrams
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D019934:International Normalized Ratio / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy; D006113:United Kingdom
D000925:Anticoagulants