CONSERVATIVE TREATMENT OF OVERANTICOAGULATED PATIENTS

Study objective: To determine the outcome of overanticoagulated patien ts who were treated with vitamin K and those who were treated conserva tively by holding doses and increasing monitoring frequency. A seconda ry objective was to compare conservative management with American Coll ege of Chest Physicians (ACCP) treatment guidelines when followed. Des ign: Retrospective chart review of all patients with international nor malized ratios (INRs) of 6 or greater and concurrently receiving warfa rin between November 1993 and February 1994. Setting: A Veterans Affai rs Medical Center providing inpatient and outpatient care. Patients re ceiving warfarin are managed by an established anticoagulation clinic. Patients: Fifty-one consecutive patients receiving warfarin who had a n INR of 6 or greater were reviewed. Interventions: Data collection in cluded INR, risks for bleeding, indication for anticoagulation, interv entions, and patient outcomes. Results: INRs ranged from 6.1 to 81.8. Forty-eight patients (94%) did not receive vitamin K; they were treate d by withholding doses and increasing monitoring frequency. One develo ped minor bleeding. Three patients (6%) received vitamin K. Two of the se patients died of unrelated problems. The third patient required 47 days of heparin therapy prior to achieving therapeutic oral anticoagul ation. Conclusion: This trial showed that conservative treatment of no nbleeding overanticoagulated patients is safe. A prospective trial com paring the ACCP guidelines with a conservative approach is needed.