AUDIT OF PATIENTS ON ORAL ANTICOAGULANTS WITH INTERNATIONAL NORMALIZED RATIOS OF 8 OR ABOVE

We reviewed retrospectively the medical records of all patients (n = 7 7, mean age 74.2) on oral anticoagulants with an International normali zed ratio (INR) of eight or above in a 12-month period in the Leiceste rshire District Health Authority (DHA). From a total of 55 625 INRs, 1 31 (0.24%) were greater than or equal to 8. A major cause of over-anti coagulation was unsatisfactory dose loading during in-hospital commenc ement of oral anticoagulation. The incidence of major bleeding was 12. 9% of total episodes of INR greater than or equal to 8 with two haemor rhage-related fatalities. Therapy of major haemorrhage with fresh froz en plasma (FFP) and intravenous (i.v.) vitamin K proved effective but was not given in a majority of such cases. In conclusion, improvements in initial dose Loading of oral anticoagulation and in the management of major haemorrhage are required. Severely over-anticoagulated patie nts without obvious bleeding should nevertheless receive small dose vi tamin It therapy to reduce the risk of haemorrhage related morbidity a nd mortality without compromising subsequent oral anticoagulant contro l.