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[Treatment for overdose of oral anticoagulants]
D M Lourenço1, V M Morelli, C V Vignal
1Escola Paulista de Medicina, UNIFESP.
Purpose:
To evaluate the response of 73 patients with antivitamin K (AVK) overdose to 3 different therapeutic regimens.
Methods:
Seventy three patients were evaluated in 94 occasions: group A (N = 32), consisted of drug withdrawal for 2 days followed by reduced dosage; group B (N = 37), drug withdrawal and reassessment within 4 days; group C (N = 25), oral administration of vitamin K. Therapeutic range was set between INR-values of 2 and 4.
Results:
Reversal regimens did not result in differences among 61 patients who had initial INR < 8 (chi 2 = 2.352, p = 0.671). There were more patients bellow therapeutic range in group C (N = 14) than group B (N = 19) (chi 2 = 9.998, p = 0.007). After intervention, 7 patients in group B still had INR > 4, but 5 of them were bellow 4.5, without increased bleeding risk. There were 10 patients in group C bellow therapeutic range, 6 of them with INR < 1.6, with risk of thromboembolism. Thirteen patients bled, but none required transfusion.
Conclusion:
Reversal of excessive oral anticoagulation can be safely performed by initial withdrawal of the drug, followed by lower doses. Vitamin K administration may lead to INR bellow the therapeutic range. This should be reserved for patients with high INR or in the presence of bleeding.