RESUMO
OBJECTIVES: The American College of Chest Physicians (ACCP) provides guidelines for the management of excessive anticoagulation in patients receiving warfarin. This multi-site prospective cohort study evaluated patient-level practice patterns and adherence to ACCP guidelines. METHODS: Patients presenting with an INR > or = 4.5 between January 3 and April 29, 2005 were observed and therapeutic management documented. Adherence was assessed retrospectively. RESULTS: Four hundred and seventeen patients from 22 centers were observed. The mean, initial INR was 7.7. At enrollment, 85% of the patients had an INR < 9 or were not bleeding; 15% were seriously bleeding. Treatment for 170 patients (41%) did not adhere to guidelines. Among those, 15% were undertreated, 48% overtreated. Lack of adherence was attributed primarily to excessive doses (mean initial dose = 6.9 mg) and inappropriate routes of administration (subcutaneous or intramuscular) of vitamin K1. CONCLUSION: Adherence to the ACCP guidelines is low. Inappropriate use of vitamin K1 is the primary reason.
