Search

Résumé Introduction Les antivitamines K (AVK) sont une cause majeure de iatrogénie. La gestion des surdosages a fait l’objet de recommandations qui font référence en France (HAS 2008). L’objectif de ce travail a été de vérifier si la prise en charge de ces situations était en adéquation avec ces recommandations. Méthode Il s’agit d’une étude rétrospective multicentrique. Cent-dix événements de surdosage ont été recensés par le laboratoire d’hémostase et ont été analysés. Résultats Cinquante-huit pour cent des prises en charge étaient en accord avec les recommandations. Néanmoins, pour les surdosages les plus importants, i.e., INR > 6, le taux d’adéquation s’établissait à 33 %. Les principales erreurs concernaient le choix d’un traitement complémentaire (vitamine K). Le taux de mortalité hospitalière de la cohorte était de 20 %. Conclusion La prise en charge hospitalière des surdosages en AVK est largement perfectible. Il est nécessaire de mettre en place des procédures visant à sécuriser les comportements des prescripteurs. Introduction Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians’ adherence to those guidelines. Methods We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed. Results Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR > 6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%. Conclusion Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians' adherence to those guidelines., Methods: We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed., Results: Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR>6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%., Conclusion: Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians., (Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)