French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding)

Abstract 

The present report from several French medical societies in the field and the French National Authority for Health provides an expert consensus for the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding). Asymptomatic VKA overdose is defined as an International Normalized Ratio (INR) value above the upper limit of the therapeutic target. In this case, the guidelines describe the rapid reduction of the INR down to the therapeutic range, either by omitting a dose or using vitamin K. Regarding the haemorrhagic complications, the guidelines address the management of these patients according to the severity of bleeding, and especially focus on the use of prothrombin complex concentrate. Finally, the consensus addresses the management of patients in cases of elective or emergency surgery or other invasive procedures, and discusses whether treatment should be continued or not, and whether VKA substitution by heparin – “bridging anticoagulation” - is needed.

Abbreviations: AF, non-valvular atrial fibrillation, INR, International Normalized Ratio, LMWH, low molecular weight heparin, PCC, prothrombin complexe concentrate, UFH, unfractionned heparin, VKA, vitamin K antagonist, VTE, In patients with venous thromboembolic disease.

Keywords: Vitamin K antagonists, Guideline, Haemorrhage, Overdose