- Poster presentation
- Open Access
Geographic variation in the reversal of vitamin K antagonist-associated coagulopathy
© BioMed Central Ltd 2008
- Published: 13 March 2008
- Gastrointestinal Bleeding
- Intracerebral Bleeding
- Fresh Freeze Plasma
- Geographical Difference
Serious bleeding is the most feared adverse effect of vitamin K antagonists (VKA) such as warfarin. VKA-treated patients who are bleeding (or found to have a supratherapeutic INR value) can be managed by administering one or more of the following: vitamin K, fresh frozen plasma, recombinant activated factor VII, or prothrombin complex concentrates. Current guidelines and review articles addressing this subject are discordant. We tested the hypothesis that significant clinical practice differences exist between North America and the rest of the world for reversal of VKA-associated coagulopathy.
A survey containing three hypothetical clinical cases was presented to attendees at a meeting of the International Society of Thrombosis and Haemostasis in July 2007. The respondents were primarily physicians with experience in anticoagulant management. The cases involved patients with an elevated INR value and either intracerebral bleeding, gastrointestinal bleeding, or no clinical evidence of bleeding. For each case, the attendee was asked to choose the intervention they would most probably order at their institution.
Comparison by region of respondents recommending prothrombin complex concentrates for each case
North America (%) (n = 10)
Other (%) (n = 36)
Significant geographical differences exist in the way clinicians urgently reverse VKA-associated coagulopathy in bleeding patients. This suggests that randomized trials are needed to define optimal management strategies.
This article is published under license to BioMed Central Ltd.