Case report

Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

Marzia Angelo¹ , Bernhard Gutmann¹ , Michele Adami¹ , Bernd Zagler¹ , Anton Zelger¹ , Christoph Pechlaner² and Christian J Wiedermann¹

¹  2^nd Division of Internal Medicine, Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy

²  Division of General Internal Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria

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Thrombosis Journal 2007, 5:1doi:10.1186/1477-9560-5-1

Published:	10 January 2007

Abstract

Recommendations for urgent reversal of oral anticoagulation with vitamin K₁ antagonists are largely derived from case series employing empirical dosing regimens with vitamin K₁ and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to ≤ 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K₁ in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.