Oral Anticoagulant Overdose and Bleeding Risk

  • C. J. Wiedermann


The major complication associated with the use of warfarin is bleeding due to excess anticoagulation. The risk of major bleeding episodes in patients treated with warfarin is related to the degree of anticoagulation. An exception to this general rule is retroperitoneal hemorrhage, which may be more common in patients taking anticoagulants, even when levels are within the therapeutic range [1]. Intracranial hemorrhage (ICH) is the most serious and lethal complication of antithrombotic therapy. Over one-half of patients with warfarin-associated ICH die within the first 3 months, a substantially higher mortality rate than that of spontaneous ICH in those not receiving anticoagulants [2, 3].


International Normalize Ratio Prothrombin Complex Concentrate Oral Anticoagulant Therapy Oral Vitamin International Normalize Ratio Range 
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  1. 1.
    Gonzalez C, Penado S, Llata L, Valero C, Riancho JA (2003) The clinical spectrum of retroperitoneal hematoma in anticoagulated patients. Medicine (Baltimore) 82:257–262PubMedCrossRefGoogle Scholar
  2. 2.
    Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884PubMedCrossRefGoogle Scholar
  3. 3.
    Sjoblom L, Hardemark HG, Lindgren A, et al (2001) Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy: a Swedish multicenter study. Stroke 32:2567–2574PubMedCrossRefGoogle Scholar
  4. 4.
    Fang MC, Chang Y, Hylek EM, Rosand J, et al (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141:745–752PubMedGoogle Scholar
  5. 5.
    Fihn SD, Gadisseur AA, Pasterkamp E, et al (2003) Comparison of control and stability of oral anticoagulant therapy using acenocoumarol versus phenprocoumon. Thromb Haemost 90:260–266PubMedGoogle Scholar
  6. 6.
    Ageno W, Crowther M, Steidl L, et al (2002) Low dose oral vitamin K to reverse acenocoumarol-induced coagulopathy: a randomized controlled trial. Thromb Haemost 88:48–51PubMedGoogle Scholar
  7. 7.
    Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E (2004) The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):204S–233SPubMedCrossRefGoogle Scholar
  8. 8.
    Clouse LH, Comp PC (1986) The regulation of hemostasis: The protein C system. N Engl J Med 314:1298–1304PubMedCrossRefGoogle Scholar
  9. 9.
    Kucher N, Connolly S, Beckman JA et al (2004) International normalized ratio increase before warfarin-associated hemorrhage: brief and subtle. Arch Intern Med 164:2176–2179PubMedCrossRefGoogle Scholar
  10. 10.
    Palareti G, Leali N, Coccheri S, et al (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet 348:423–428PubMedCrossRefGoogle Scholar
  11. 11.
    Fitzmaurice DA, Blann AD, Lip GY (2002) Bleeding risks of antithrombotic therapy. BMJ 325:828PubMedCrossRefGoogle Scholar
  12. 12.
    Veeger NJ, Piersma-Wichers M, Tijssen JG, Hillege HL, van der Meer J (2005) Individual time within target range in patients treated with vitamin K antagonists: main determinant of quality of anticoagulation and predictor of clinical outcome. A retrospective study of 2300 consecutive patients with venous thromboembolism. Br J Haematol 128:513–519PubMedCrossRefGoogle Scholar
  13. 13.
    Oden A, Fahlen M (2002) Oral anticoagulation and risk of death: a medical record linkage study. BMJ 325:1073–1075PubMedCrossRefGoogle Scholar
  14. 14.
    Beyth RJ, Quinn LM, Landefeld CS (1998) Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med 105:91–99PubMedCrossRefGoogle Scholar
  15. 15.
    Penning-van Beest FJ, van Meegen E, Rosendaal FR, Stricker BH (2001) Characteristics of anticoagulant therapy and comorbidity related to overanticoagulation. Thromb Haemost 86:569–574PubMedGoogle Scholar
  16. 16.
    Visser LE, Bleumink GS, Trienekens PH, Vulto AG, Hofman A, Stricker BH (2004) The risk of overanticoagulation in patients with heart failure on coumarin anticoagulants. Br J Haematol 127:85–89PubMedCrossRefGoogle Scholar
  17. 17.
    Pautas E, Gouin-Thibault I, Debray M, Gaussem P, Siguret V (2006) Haemorrhagic complications of vitamin K antagonists in the elderly. Risk factors and management. Drugs Aging 23: 13–25PubMedCrossRefGoogle Scholar
  18. 18.
    Dentali F, Ageno W, Crowther M (2006) Treatment of coumarin-associated coagulopathy: a systematic review and proposed treatment guidelines. J Thromb Haemost 4:1853–1863PubMedCrossRefGoogle Scholar
  19. 19.
    Kessler CM (2006) Urgent reversal of warfarin with prothrombin complex concentrate: where are the evidence-based data? J Thromb Haemost 4:963–966PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • C. J. Wiedermann
    • 1
  1. 1.Division of Internal Medicine 2 Department of MedicineCentral HospitalBolzanoItaly

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