vitamin-k-semiquinone-radical and Compartment-Syndromes

Successful vitamin K antagonist (eg, warfarin) reversal with 4-factor prothrombin complex concentrate (4F-PCC) without vitamin K (phytonadione) for emergent surgery in a patient at moderate-to-high risk for thromboembolism is reported. This approach may decrease the risk for development of thrombus, as it limits the amount of time the patient's anticoagulation is subtherapeutic. It also may increase the risk of bleeding, so patient selection is essential if this strategy is employed. Caution must be exercised to complete the procedure or surgery in the window of peak 4F-PCC effect (∼1-6 hours postinfusion).

Topics: Accidents, Traffic; Aged; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Blood Coagulation Factors; Compartment Syndromes; Crush Injuries; Drug Hypersensitivity; Fibula; Fractures, Bone; Humans; International Normalized Ratio; Leg Injuries; Male; Preoperative Care; Stroke; Vitamin K; Warfarin

The aim of the study was to evaluate potential differences between patients with spontaneous and non-spontaneous bleeding episodes during treatment with vitamin K antagonists which mainly resulted in compartment syndromes.. The population in this study comprised 116 patients who suffered at least one bleeding complication which required surgical treatment during therapy with an oral vitamin K antagonist. The patients were treated between September 2001 and July 2008.. Significant differences were observed between the two patient groups with regard to the presence of renal failure, arterial hypertension, and diabetes mellitus, which occurred more frequently in patients with spontaneous bleeding. Also, significantly more patients with spontaneous bleedings developed compartment syndrome that needed emergency operation. Overall mortality was 9.6 %, was associated with multiorgan failure in all patients, and was not different between the two patient groups.. The identification of high-risk patients before treatment with an oral vitamin K antagonist is of major importance. The existence of over-anticoagulation syndrome and compartment syndrome is associated with significant mortality and morbidity and should not be underestimated.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Algorithms; Anticoagulants; Compartment Syndromes; Female; Germany; Hemorrhage; Humans; International Normalized Ratio; Length of Stay; Male; Middle Aged; Phenprocoumon; Retrospective Studies; Risk; Tomography, X-Ray Computed; Vitamin K

Topics: 4-Hydroxycoumarins; Adult; Blood Transfusion; Compartment Syndromes; Female; Hemothorax; Humans; Infusions, Intravenous; International Normalized Ratio; Leg; Plasma; Rodenticides; Suicide, Attempted; Ultrasonography, Doppler; Vitamin K