Predictive factors of recurrence in patients admitted to emergency department with vitamin K antagonists overdose
Introduction:
Prescription of vitamin k antagonists (VKA) is very common actually. VKA overdose is frequent in patients admitted to emergency department (ED). The most common adverse reaction from this therapy is bleeding which had a life threatening impact. The management of VKA overdose in ED should consider predictive factors of recurrence to ovoid future complications.
The aim of our study was to identify predictive factors of recurrence in patients admitted to ED with VKA overdose.
Methods:
Prospective observational study during three years. We included adult patients admitted to ED for VKA overdose (INR over the therapeutic range) and patients who experienced VKA overdose during their hospitalization in ED.
Collection of data including demographics, indications of VKA, VKA dose, comorbidities, chief complaints, physical examination, lab data including INR measurements and treatment at the ED. Follow-up during during one year. Univariate analysis.
Results:
Inclusion of 186 patients. Mean age = 67 ±12 years. Sex-ratio=0,8. VKA indications n(%) : Atrial fibrillation 117(66), mechanical valve replacement 37(2), thrombosis 15(8.5).
Chief complaints n(%): bleeding 58(31), ecchymosis 15(8). Sixty percents of patients were asymptomatic (n=112). Mean INR : 5,7 ±3,5. INR was immeasurable in 39 patients (21%). Causes of overdose were n(%): lack of monitoring 165(88), wrong dose intake 2(1.1), drug interaction 6(3), recent initiation of VKA 10(5.5). Treatment n(%): VKA one day withdrawal 171 (92), change in posology 173(93), vitamin K 80(43), PTCC 4(2).
Follow-up was possible in 68 patients. Recurrence of VKA overdose was observed in 28 patients. Univariate analysis identified immeasurable INR as predictive factor of recurrence (p=0.002).
Conclusion:
The early identifications of predictive factors of recurrence and mortality lead to improve our management and to improve the prognosis of patients
