[Vitamine K antagonists overdose: Physician adherence to the French guidelines]

Rev Med Interne. 2018 May;39(5):321-325. doi: 10.1016/j.revmed.2018.02.019. Epub 2018 Mar 14.
[Article in French]

Abstract

Introduction: Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians' adherence to those guidelines.

Methods: We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed.

Results: Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR>6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%.

Conclusion: Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians.

Keywords: Adverse effects; Anticoagulants; Guidelines; Iatrogénie; International normalized ratio; Recommandations; Vitamin K; Vitamine K.

Publication types

  • Multicenter Study

MeSH terms

  • 4-Hydroxycoumarins / adverse effects*
  • 4-Hydroxycoumarins / therapeutic use
  • Aged
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Drug Overdose
  • Female
  • France
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Indenes / adverse effects*
  • Indenes / therapeutic use
  • International Normalized Ratio / methods*
  • Male
  • Middle Aged
  • Physicians
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Vitamin K / adverse effects
  • Vitamin K / antagonists & inhibitors*
  • Vitamin K / therapeutic use

Substances

  • 4-Hydroxycoumarins
  • Anticoagulants
  • Indenes
  • antivitamins K
  • Vitamin K