RESUMO
OBJECTIVE: To assess compliance and impact of a teaching program on guidelines for the management of severe bleeding under oral anticoagulation therapy in emergency departments (EDs). DESIGN AND SETTING: Multicenter, before-after observational studies in six French EDs. PATIENTS: Forty-five patients in 2003 and 54 patients in 2005 consecutively admitted with severe bleeding under oral anticoagulation therapy. INTERVENTIONS: A specific teaching program on management of severe bleeding under oral anticoagulation therapy, performed by an expert physician. MEASUREMENTS AND RESULTS: Primary end-point was the use of prothrombin complex concentrate-vitamin K association between the two study periods. Nine patients (20%) in 2003 and 29 patients (54%) in 2005 received this association (P < 0.01). Almost one-third of patients had only withholding oral anticoagulation therapy. Adverse events and mortality rate did not differ between the two phases. CONCLUSIONS: Compliance with guidelines on the management of severe bleeding under oral anticoagulation remains poor and might be improved by specific teaching program.
