Prise en charge des hémorragies sous antivitamine K en 2008 : Enfin des recommandations !

Management of bleeding under anticoagulation therapy remains a major challenge regarding the frequency and the dramatic prognosis of this event. Clinical guidelines could improve specific management of such events. Several gravity factors are defined in the future guidelines. In case of severe bleedings, fundamental treatment consists in rapid reversal of anticoagulation as soon as diagnostic confirmed. Normalization of coagulation could improve the delay of management, especially in case of operational indication. Prothrombin complex factors in association with vitamin K are recommended and must be administered before INR value results. This association provides adequate and durable coagulation in a few minutes, without adverse event. In case of non severe bleedings, the intensity of hemorrhage and its early evolution after initial haemostatic therapy will influence the management of anticoagulation. General medical procedures might be useful to standardize medical practices. The restarting of anticoagulation would be discussed for each patient by medico surgical staff. In case of intracranial hemorrhage, normo coagulation must be tolerate for at least 7 days. Future recommendations of a French task force will provide specific guidelines to improve management of bleeding under anticoagulation therapy.