title: Warfarin reversal: an audit of prescribing practices at Capital and Coast District Health Board.
abstract: OBJECTIVE
  In March 2013 the Australasian Society of Thrombosis and Haemostasis published an update of the Consensus Guidelines for Warfarin Reversal.3 We reviewed the prescribing practices at Capital and Coast District Health Board (CCDHB), following publication of the updated guidelines.
  
  
  METHODS
  Patients were identified through multiple sources. CCDHB Medical Records identified admissions coded as "Haemorrhagic disorder due to circulating anticoagulants" or "Anticoagulants causing adverse effects in therapeutic use". CCDHB Haematology Laboratory identified International Normalised Ratio (INR) results greater than or equal to 4.5. Wellington Hospital Pharmacy identified patients dispensed vitamin K. New Zealand Blood Service identified recipients of Prothrombinex-VF(reg.) and Fresh Frozen Plasma (FFP).
  
  
  RESULTS
  The management of patients with elevated INR results or bleeding on warfarin therapy was consistent with the updated guidelines in 81/149 episodes. Thirty one patients received FFP unnecessarily and 24 patients did not receive Prothrombinex-VF when indicated. The greatest variability in management occurred in patients with bleeding complications and in patients requiring urgent warfarin reversal to allow acute surgery to proceed with only 5/31 patients and 5/21 patients having warfarin reversed as recommended. In some episodes more than one error was identified.
  
  
  CONCLUSIONS
  The audit identified the suboptimal use of Prothrombinex-VF and the unnecessary use of FFP in the management of warfarin reversal.
authors.forename: Evan
authors.initials: E
authors.lastname: Jolliffe
authors.affiliation: New Zealand Blood Service, 11 Great South Road, Epsom, Auckland 1051, New Zealand. Peter.Flanagan@nzblood.co.nz.
authors.forename: Peter
authors.initials: P
authors.lastname: Flanagan
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio; D008485:Medical Audit; D009520:New Zealand; D010949:Plasma; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014859:Warfarin