Hemorrhagic complications during warfarin therapy
Gumulec J.1, Kessler P.2, Penka M.3, Klodová D.1, Králová S.1, Brejcha M.1, Wróbel W.1, Šumná E.1, Blatný J.3, Klaricová K.1, Riedlová P.1, Lasota Z.
1Onkologické centrum J. G. Mendela Nový Jičín 2Oddělení hematologie a transfuziologie Nemocnice v Pelhřimově3Oddělení klinické hematologie Fakultní nemocnice Brno |
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Summary:
Hemorrhage is probably the major complication of anticoagulant treatment with vitamin K antagonists represented
particularly by warfarin in our country. The main risk factors of hemorrhagic complications of “warfarinisation” are
intensity and instability of the anticoagulant therapy, individual patient characteristics, drug interactions, and duration
of the anticoagulant therapy. Severe hemorrhage in patients treated with warfarin is most effectively prevented by fast
and complete suppression of anticoagulant effect of the drug using a prothrombin complex concentrate and slow intravenous
vitamin K1 infusion regardless of the reason for anticoagulation. This approach can minimize frequencies of
hemorrhage consequences. Less severe or asymptomatic hemorrhage with an increased international normalized ratio
can be effectively treated by withdrawal or reduction of warfarin dosage and/or peroral administration of vitamin K1
(intravenous administration only in selected high-risk cases). The latter results only in a partial correction of coagulopathy,
nevertheless to a such extend that is required with respect to the risk of recurrence of thrombotic event. The objective
of this article is to contribute to the standardization of the treatment for patients overdosed with warfarin and/or for
patients with hemorrhagic complications due to warfarin therapy. It is available at www.trombosis.cz. The guidelines
include a handbook that is used for immediate, and very quick orientation in the clinical praxis.
Key words:
warfarin, hemorrhage, vitamin K, prothrombin complex concentrate, plasma, recombinant activated factor
VII.
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