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Teaching improves adherence to clinical guidelines in the treatment of oral anticoagulation-related severe bleeding in the emergency department

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Abstract

Objective

To assess compliance and impact of a teaching program on guidelines for the management of severe bleeding under oral anticoagulation therapy in emergency departments (EDs).

Design and setting

Multicenter, before–after observational studies in six French EDs.

Patients

Forty-five patients in 2003 and 54 patients in 2005 consecutively admitted with severe bleeding under oral anticoagulation therapy.

Interventions

A specific teaching program on management of severe bleeding under oral anticoagulation therapy, performed by an expert physician.

Measurements and results

Primary end-point was the use of prothrombin complex concentrate–vitamin K association between the two study periods. Nine patients (20%) in 2003 and 29 patients (54%) in 2005 received this association (P < 0.01). Almost one-third of patients had only withholding oral anticoagulation therapy. Adverse events and mortality rate did not differ between the two phases.

Conclusions

Compliance with guidelines on the management of severe bleeding under oral anticoagulation remains poor and might be improved by specific teaching program.

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References

  1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. bénéfice AVK 285:2370–2375

    CAS  Google Scholar 

  2. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 329:15–19

    Article  PubMed  Google Scholar 

  3. Fitzmaurice DA, Blann AD, Lip GY (2002) Bleeding risks of antithrombotic therapy. BMJ 325:828–831

    Article  PubMed  Google Scholar 

  4. Huttner HB, Schellinger PD, Hartmann M, Kohrmann M, Juettler E, Wikner J, Mueller S, Meyding-Lamade U, Strobl R, Mansmann U, Schwab S, Steiner T (2006) Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates. Stroke 37:1465–1470

    Article  PubMed  CAS  Google Scholar 

  5. Vigue B, Ract C, Tremey B, Engrand N, Leblanc PE, Decaux A, Martin L, Benhamou D (2007) Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Med 33:721–725

    Article  PubMed  CAS  Google Scholar 

  6. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G (2008) Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:160S–198S

    Article  PubMed  CAS  Google Scholar 

  7. Baglin TP, Keeling DM, Watson HG (2006) Guidelines on oral anticoagulation (warfarin): third edition-2005 update. Br J Haematol 132:277–285

    Article  PubMed  CAS  Google Scholar 

  8. HAS (2008) Prise en charge des surdosages, des accidents hémorragiques et des situations à risque hémorragiques, chez les patients traités par antivitamines K en ville et en milieu hospitalier. STV 20:69–83

    Google Scholar 

  9. Haverkamp D, Hutten BA, Buller HR, Gallus AS, Lensing AW, Prins MH (2003) The use of specific antidotes as a response to bleeding complications during anticoagulant therapy for venous thromboembolism. J Thromb Haemost 1:69–73

    Article  PubMed  CAS  Google Scholar 

  10. Sjoblom L, Hardemark HG, Lindgren A, Norrving B, Fahlen M, Samuelsson M, Stigendal L, Stockelberg D, Taghavi A, Wallrup L, Wallvik J (2001) Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy: a Swedish multicenter study. Stroke 32:2567–2574

    Article  PubMed  CAS  Google Scholar 

  11. Appelboam R, Thomas EO (2007) The headache over warfarin in British neurosurgical intensive care units: a national survey of current practice. Intensive Care Med 33:1946–1953

    Article  PubMed  CAS  Google Scholar 

  12. Evans SJ, Biss TT, Wells RH, Hanley JP (2008) Emergency warfarin reversal with prothrombin complex concentrates: UK wide study. Br J Haematol 141:268–269

    Article  PubMed  CAS  Google Scholar 

  13. Pabinger I, Brenner B, Kalina U, Knaub S, Nagy A, Ostermann H (2008) Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost 6:622–631

    Article  PubMed  CAS  Google Scholar 

  14. Cannegieter SC, Rosendaal FR, Briet E (1994) Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89:635–641

    PubMed  CAS  Google Scholar 

  15. Kearon C, Hirsh J (1997) Management of anticoagulation before and after elective surgery. N Engl J Med 336:1506–1511

    Article  PubMed  CAS  Google Scholar 

  16. Ashton A, Bhati R (2007) The use of an asynchronous learning network for senior house officers in emergency medicine. Emerg Med J 24:427–428

    Article  PubMed  CAS  Google Scholar 

  17. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115:2689–2696

    Article  PubMed  CAS  Google Scholar 

  18. Flaherty ML, Haverbusch M, Sekar P, Kissela BM, Kleindorfer D, Moomaw CJ, Broderick JP, Woo D (2006) Location and outcome of anticoagulant-associated intracerebral hemorrhage. Neurocrit Care 5:197–201

    Article  PubMed  Google Scholar 

  19. Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141:745–752

    PubMed  Google Scholar 

  20. Koo S, Kucher N, Nguyen PL, Fanikos J, Marks PW, Goldhaber SZ (2004) The effect of excessive anticoagulation on mortality and morbidity in hospitalized patients with anticoagulant-related major hemorrhage. Arch Intern Med 164:1557–1560

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the LFB company (Courtaboeuf, France) for financial support. Research assistant sponsoring by LFB society helped physicians in each center to collect data.

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Authors and Affiliations

  1. Department of Anesthesiology, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France

    Benjamin Tremey

  2. Section of Emergency Medicine, Centre Hospitalier Marc Jacquet, 11 rue Freteau de Peny, 77011, Melun Cedex, France

    Karim Tazarourte

  3. Department of Anesthesiology and Critical Care, Centre Hospitalier Général Universitaire de Bicêtre, 78 rue du General Leclerc, 94275, Le Kremlin, Bicêtre cedex, France

    Catherine Ract & Bernard Vigué

  4. Section of Emergency Medicine, Centre Hospitalier Universitaire de Tours, 37000, Tours cedex, France

    Mahjoub Gabteni

  5. Section of Emergency Medicine, Centre Hospitalier Universitaire Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Leila Lavagna

  6. Section of Emergency Medicine, Centre Hospitalier Universitaire de Bicêtre, 78 rue du General Leclerc, 94275, Le Kremlin Bicêtre cedex, France

    Jacqueline Dépret-Vassal

  7. Section of Emergency Medicine, Centre Hospitalier d’Orléans, BP 6709, 45067, Orléans cedex 02, France

    Valérie Ségalin

  8. Section of Emergency Medicine, Centre Hospitalier de Lagny, 31 avenue du Général Leclerc, 77405, Lagny sur Marne, France

    Stéphane Saintonge

Authors
  1. Benjamin Tremey
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  2. Karim Tazarourte
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  3. Catherine Ract
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  4. Mahjoub Gabteni
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  5. Leila Lavagna
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  6. Jacqueline Dépret-Vassal
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  7. Valérie Ségalin
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  8. Stéphane Saintonge
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  9. Bernard Vigué
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Corresponding author

Correspondence to Benjamin Tremey.

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Tremey, B., Tazarourte, K., Ract, C. et al. Teaching improves adherence to clinical guidelines in the treatment of oral anticoagulation-related severe bleeding in the emergency department. Intensive Care Med 35, 1444–1448 (2009). https://doi.org/10.1007/s00134-009-1465-9

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  • DOI: https://doi.org/10.1007/s00134-009-1465-9

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