Takeaway
- Uncorrected international normalised ratio (INR) is an important risk factor for mortality in vitamin K antagonist (VKA)-associated major bleeding for both intracranial haemorrhage (ICH) and non-ICH patients.
- Higher doses of vitamin K are more effective in correcting INR.
Why this matters
- Findings suggest that correction of haemostatic assays could be used in future trials to predict the efficacy of reversal agents.
Study design
- This multicentre UK study included 1771 patients on VKA who were hospitalised for major bleeding using prospectively collected hospital data.
- Associations between INR correction and 30-day mortality and vitamin K dose were estimated.
- Funding: British Society for Haematology Early Stage Research Fellowship.
Key results
- Overall, 77%, 73.2% and 33% received prothrombin-complex-concentrate (PCC), vitamin K (92% intravenous [IV]) and red blood cells and fresh frozen plasma transfusion, respectively.
- PCC administration was higher for ICH cases (87%) than non-ICH cases (69%).
- Vitamin K was administered most commonly in 10 mg (33%) and 5 mg (28%) doses, with no significant difference between ICH and non-ICH cases.
- Higher doses of vitamin K (10 mg) were more likely to correct INR than lower doses (5 mg).
- Post-intervention INR >1.3 vs INR ≤1.3 in treated patients was associated with an increased risk of mortality within 30 days (adjusted OR, 3.26; 95% CI, 2.13-4.98; P<.001), with no difference between ICH and non-ICH cases.
Limitations
- Possibility of residual confounding.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
