title: Spontaneous and non-spontaneous bleeding complications in patients with oral vitamin K antagonist therapy.
abstract: OBJECTIVE
  The aim of the study was to evaluate potential differences between patients with spontaneous and non-spontaneous bleeding episodes during treatment with vitamin K antagonists which mainly resulted in compartment syndromes.
  
  
  METHODS
  The population in this study comprised 116 patients who suffered at least one bleeding complication which required surgical treatment during therapy with an oral vitamin K antagonist. The patients were treated between September 2001 and July 2008.
  
  
  RESULTS
  Significant differences were observed between the two patient groups with regard to the presence of renal failure, arterial hypertension, and diabetes mellitus, which occurred more frequently in patients with spontaneous bleeding. Also, significantly more patients with spontaneous bleedings developed compartment syndrome that needed emergency operation. Overall mortality was 9.6 %, was associated with multiorgan failure in all patients, and was not different between the two patient groups.
  
  
  CONCLUSIONS
  The identification of high-risk patients before treatment with an oral vitamin K antagonist is of major importance. The existence of over-anticoagulation syndrome and compartment syndrome is associated with significant mortality and morbidity and should not be underestimated.
authors.affiliation: Clinic for Surgery, University Clinic of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany, drmartinhoffmann@googlemail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Meyer
authors.forename: Tilman
authors.initials: T
authors.lastname: Laubert
authors.forename: Nehara
authors.initials: N
authors.lastname: Begum
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.forename: Peter
authors.initials: P
authors.lastname: Kujath
authors.forename: Erik
authors.initials: E
authors.lastname: Schloericke
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003161:Compartment Syndromes / Q000097:blood* / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D010644:Phenprocoumon