Hemorrhagic complications of antivitamin K treatment in a series of 75 patients.

Hemorrhagic complications are the most frequent complications of antivitami n K (AVK) treatments and can be life-threatening. We report 75 patients fro m a University Hospital. They were 40 males and 35 females (median age 74 y ears, 20-94), and were classified into 3 grades according to clinical pictu re: grade 1 (no surgery or transfusion, grade 2: surgery or blood transfusi on needed, grade 3: death). 43 patients had grade 1 complications, 27 grade 2, and 5 grade 3 complications. The most frequent complications were muscu lar hematomas (36 patients), sub-cutaneous hematomas (14 patients), digesti ve bleeding (13 patients), hematuria (12 subjects). Eight patients had intr acerebral bleeding, of whom 3 died. The treatment time was very variable (1 to 988 weeks). Only half patients had a prothrombin rate (PR) below 20% bu t two thirds had an INR above 5. This study showed that PR was a poor predi ctor of hemorrhagic complications. INR was a better parameter. For 15 patie nts, we considered that the indication was unadapted or questionable, among whom 2 died. This work suggests that the promotion of AVK prescription rul es should go on.