Vitamin K antagonists (VKAs) are the most commonly-used anticoagulant treatments for
the prevention of thrombotic and embolic events related to atrial fibrillation, venous
thromboembolism (VTE), and prosthetic heart valve. The incidence of major bleedings
has been estimated at 7%, and that of fatal bleedings at 1% [
[1]
]. The primary bleeding complications observed in patients receiving long-term VKA
therapy are either gastrointestinal (30–60% of cases) or cerebral (17–30%) [
2
,
3
]. The current guidelines recommend administering four-factor PCC (4 F-PCC) rather
than FFP to reverse VKA-induced coagulopathy in patients suffering from major VKA-associated
bleedings, while optimal dosage protocols have not yet been clearly defined, thus
differing widely [
4
,
5
,
- Holbrook A.
- Schulman S.
- Witt D.M.
- et al.
American College of Chest Physicians. Evidence-based management of anticoagulant therapy:
antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest
Physicians Evidence-based Clinical Practice Guidelines.
Chest. 2012; 141: e152S-e184S
6
,
7
]. The effect of VKA treatment on procoagulant factor levels is well-known, causing
a decrease in FII, FVII, FIX, FX, and proteins C and S, yet no decrease in fibrinogen,
FV, FVIII, FXI, or in antithrombin. However, only a few studies have investigated
blood coagulation factors in bleeding events under VKAs, and a clearer understanding
of the coagulation factor losses specific to each bleeding type would enable us to
optimize currently-recommended treatments by adapting them to bleeding type and lost
blood volume. With this study, we sought to compare the levels of blood coagulation
factors in patients receiving VKAs and exhibiting serious gastrointestinal or intracranial
bleeding.Keywords
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References
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- American College of Chest Physicians. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines.Chest. 2012; 141: e152S-e184S
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Article info
Publication history
Published online: May 18, 2016
Accepted:
May 2,
2016
Received in revised form:
April 29,
2016
Received:
April 11,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
