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Predictive factors of mortality in patients admitted to the emergency department with vitamin K antagonists overdose
PRESCRIPTION of vitamin K antagonist (AVK) is very common nowadays. VKA overdose is frequently diagnosed in patients admitted to the emergency department (ED). The most common adverse reaction is bleeding causing life threatening situation. The aim of our study was to identify predictive factors of mortality in patients admitted to the ED with VKA overdose.
METHODS A three-year prospective observational study. a total od 141 adult patients admitted to the ED for VKA overdose (INR over the therapeutic range ) were included in this study . Follow-up during one year. Univariate and multivariate analyses were used to identify predictive factors of mortality.
RESULTS Inclusion of 141 patients. Mean age= 66 ±12 ans. Sex-ratio=0, 9. VKA indications n (%) : Atrial fibrillation 85(60), mechanical valve replacement 29(21), thrombosis 10(7). Asymptomatic patients: 69% (n=97). Mean INR: 5, 5 ±3, 5. INR was unmeasurable in 29 patients. Treatment n (%): VKA one day withdrawal 130(92), change in posology 138(98), vitamin K 48(34), PTCC 3(2). Recurrence was observed in 20 patients (35%). Mortality rate was 21% (n=12). Multivariate analysis identi#ed two independent factors as predictors of mortality at one year: age more than 69 years (adjusted OR 5.9 ; p=0.001; IC 95% [2.013-17.389]) and hemoglobin less than 10,85 (adjusted OR 2.53 ; p=0.016 ; IC
95% [1.192-5.392]).
CONCLUSION Age and anemia were identi#ed as predictive factors of mortality in patients admitted to ED with VKA overdose. The early identi#cation of these factors at admission may improve our management. !e correction of anemia may be integrated in the routine procedures of ED management of over- anticoagulation.
Predictive factors of mortality in patients admitted to the emergency department with vitamin K antagonists overdose
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