Liabeuf et al reported risk factors for major bleeding in a patient with an elevated INR due to vitamin K antagonist (VKA) therapy. This can help to identify a patient who may benefit from more aggressive management. The authors are from Centre Hospitalier Universitaire Amiens Sud and Universite de Picardie Jules Verne in France.

Patient selection: VKA-treated hospitalized patient with INR >= 5


Serious bleeding: life-threatening or fatal, cause chronic sequelae, consume major health-care resources


Risk factors for serious bleeding by multivariate analysis:

(1) INR >= 8.5

(2) history of recent gastrointestinal tract lesion

(3) trauma in the preceding 2 weeks

(4) known noncompliance with VKA therapy


The risk of serious bleeding increases with the number of risk factors present.

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