title: Compliance with guidelines for the perioperative management of vitamin K antagonists.
abstract: BACKGROUND
  Perioperative vitamin K antagonist management is an issue of concern in many countries. The availability of best practice guidelines meets health professionals' needs, but compliance is uncertain and should be assessed.
  
  
  METHODS
  Our aim was to assess practitioner compliance with the guidelines on perioperative VKA management issued by the French National Authority for Health through a national register set up in partnership with the French College of Anaesthetists and Intensivists. Seven sections of data entry were focused on perioperative management of VKAs for elective or emergency procedures. High-risk patients were identified. Compliance with guidelines was calculated per item
  
  
  RESULTS
  932 charts were completed between October 2009 and December 2010. VKA therapy was interrupted in 74% (622/837) of elective procedures and bridged in 69% cases (428/622) mainly with LMWH. According to guidelines, bridging was strongly recommended in 39% high-risk patients (175/394) but 13% of these (23/175) received no bridging. Bridging was overused in 60% of low risk patients (242/406). Other compliance rates were as follows: (i) administration of therapeutic enoxaparin doses (=200IU/kg/day): only 18% of high-risk patients (18/98), (ii) INR measurement on evening prior to the procedure 65% (525/803), (iii) concomitant prothrombin complex concentrate and vitamin K administration in emergency surgery 24% (21/87), (iv) postoperative therapeutic enoxaparin doses: only 20% despite widespread prescription. The incidence rate of bleeding and thrombotic events was 7.1% and 0.96% respectively.
  
  
  CONCLUSIONS
  These poor compliance rates with guidelines suggest that the knowledge-to-action transfer plan was inadequate and that further interventions are required.
authors.affiliation: Department of Anaesthesiology, University Hospital (Nouvel Hôpital Civil), Strasbourg, France. Electronic address: annick.Steib@chru-strasbourg.fr.
authors.forename: Annick
authors.initials: A
authors.lastname: Steib
authors.affiliation: Department of Anaesthesiology, University Hospital (Nouvel Hôpital Civil), Strasbourg, France.
authors.forename: Paul-Michel
authors.initials: PM
authors.lastname: Mertes
authors.affiliation: Department of Anaesthesiology, Hôpital Tenon, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.affiliation: Department of Anaesthesiology, University Hospital, Grenoble, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: Department of Anaesthesiology, University Hospital, tours, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Fusciardi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000592:standards; D011787:Quality of Health Care; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Continuing Professional Development; Evaluation of practice; Guidelines; Quality; Register; Vitamin K Antagonist