title: Management Strategies for Vitamin K Antagonists Reversal in Patients With Major Bleeding: A Survey of Italian Emergency Departments.
abstract: OBJECTIVE
  Emergency physicians frequently deal with patients on vitamin K antagonists (VKAs) suffering major bleeding events, and rapid reversal of anticoagulation in this setting is of paramount importance. In Italy, given the absence of specific national guidelines, local policies are likely to differ, possibly impacting on clinical outcomes. We decided to perform a telephone survey among Italian emergency physicians to evaluate management strategies for VKAs reversal in patients with major bleeding.
  
  
  METHODS
  We conducted a computer-assisted, 10-minute telephone survey of 15 questions, focusing on the local prevalence, assessment, and management strategies of major and intracranial hemorrhage (ICH) occurring in patients on VKAs. We planned to interview a sample of 320 Italian emergency physicians. Institutions from all geographic areas of Italy were to participate in the survey.
  
  
  RESULTS
  Of the 320 physicians contacted, 150 (47%) completed the survey, 95% being employed in public hospitals. Focusing on ICH, only 29% of the responders stated they would reverse anticoagulation irrespective of the international normalized ratio value, and only 27% would use prothrombin-complex concentrate as first-line agent. In patients needing urgent neurosurgical operation, less than 50% would administer prothrombin-complex concentrate before surgery.
  
  
  CONCLUSIONS
  The average knowledge of management strategies for reversal of anticoagulation displayed by Italian emergency physicians appears to be unsatisfactory. The need for an extensive educational program and for the implementation of specific guidelines, possibly endorsed by Scientific Societies, cannot be underemphasized.
authors.affiliation: Pronto Soccorso, ULSS7-Pieve di Soligo, Conegliano, Italy enrico.bernardi@ulss7.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bernardi
authors.affiliation: UOC Medicina Interna Centro Emostasi e Trombosi, Ospedale "Guglielmo da Saliceto", Piacenza, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Imberti
authors.affiliation: Dipartimento Emergenza-Urgenza, Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferrari
mesh_terms: D004636:Emergency Service, Hospital; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007558:Italy; D011795:Surveys and Questionnaires; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D014812:Vitamin K
keywords: anticoagulants; bleeding; hemostasis