Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

• Main Authors: Pechlaner Christoph, Zelger Anton, Zagler Bernd, Adami Michele, Gutmann Bernhard, Angelo Marzia, Wiedermann Christian J
• Format: Article
• Language: English
• Published: BMC 2007-01-01
• Series: Thrombosis Journal
• Online Access: http://www.thrombosisjournal.com/content/5/1/1
• ISSN: 1477-9560

<p>Abstract</p> <p>Recommendations for urgent reversal of oral anticoagulation with vitamin K₁antagonists are largely derived from case series employing empirical dosing regimens with vitamin K₁and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to ≤ 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K₁in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.</p>