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Management Strategies for Vitamin K Antagonists Reversal in Patients With Major Bleeding

机译：维生素K拮抗剂的管理策略逆转重大出血患者

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摘要

Emergency physicians frequently deal with patients on vitamin K antagonists (VKAs) suffering major bleeding events, and rapid reversal of anticoagulation in this setting is of paramount importance. In Italy, given the absence of specific national guidelines, local policies are likely to differ, possibly impacting on clinical outcomes. We decided to perform a telephone survey among Italian emergency physicians to evaluate management strategies for VKAs reversal in patients with major bleeding. We conducted a computer-assisted, 10-minute telephone survey of 15 questions, focusing on the local prevalence, assessment, and management strategies of major and intracranial hemorrhage (ICH) occurring in patients on VKAs. We planned to interview a sample of 320 Italian emergency physicians. Institutions from all geographic areas of Italy were to participate in the survey. Of the 320 physicians contacted, 150 (47%) completed the survey, 95% being employed in public hospitals. Focusing on ICH, only 29% of the responders stated they would reverse anticoagulation irrespective of the international normalized ratio value, and only 27% would use prothrombin-complex concentrate as first-line agent. In patients needing urgent neurosurgical operation, less than 50% would administer prothrombin-complex concentrate before surgery. The average knowledge of management strategies for reversal of anticoagulation displayed by Italian emergency physicians appears to be unsatisfactory. The need for an extensive educational program and for the implementation of specific guidelines, possibly endorsed by Scientific Societies, cannot be underemphasized.
机译：急诊医生经常与维生素K拮抗剂（VKAS）的患者造成重大出血事件，并且在这种环境中的抗凝迅速逆转是至关重要的。在意大利，鉴于缺乏具体的国家指导方针，地方政策可能会有所不同，可能影响临床结果。我们决定在意大利应急医生进行电话调查，以评估重大出血患者VKAS逆转的管理策略。我们开展了一项电脑辅助，10分钟的电话调查，重点，重点是在VKAS上患者发生的主要和颅内出血（ICH）的当地普遍存在，评估和管理策略。我们计划采访320例意大利应急医生的样本。来自意大利的所有地理区域的机构都参加了调查。在320名医生接触中，150名（47％）完成了调查，95％的公立医院受雇。专注于ICH，只有29％的响应者表示，无论国际归一化比率值如何，只有27％的人将使用凝血酶原浓缩物作为一线剂。在需要紧急神经外科手术的患者中，小于50％的人将在手术前施用凝血酶原浓缩物。意大利应急医生展示的抗凝逆转管理策略的平均知识似乎不满意。需要广泛的教育计划和实施特定指南，可能受到科学社会的认可，不能强调。

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