Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation.
Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to <or= 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K1 in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.
Angelo
Marzia
M
2nd Division of Internal Medicine, Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy. marzia.angelo@asbz.it
Gutmann
Bernhard
B
Adami
Michele
M
Zagler
Bernd
B
Zelger
Anton
A
Pechlaner
Christoph
C
Wiedermann
Christian J
CJ