Teaching improves adherence to clinical guidelines in the treatment of oral anticoagulation-related severe bleeding in the emergency department.

OBJECTIVE

To assess compliance and impact of a teaching program on guidelines for the management of severe bleeding under oral anticoagulation therapy in emergency departments (EDs).

DESIGN AND SETTING

Multicenter, before-after observational studies in six French EDs.

PATIENTS

Forty-five patients in 2003 and 54 patients in 2005 consecutively admitted with severe bleeding under oral anticoagulation therapy.

INTERVENTIONS

A specific teaching program on management of severe bleeding under oral anticoagulation therapy, performed by an expert physician.

MEASUREMENTS AND RESULTS

Primary end-point was the use of prothrombin complex concentrate-vitamin K association between the two study periods. Nine patients (20%) in 2003 and 29 patients (54%) in 2005 received this association (P < 0.01). Almost one-third of patients had only withholding oral anticoagulation therapy. Adverse events and mortality rate did not differ between the two phases.

CONCLUSIONS

Compliance with guidelines on the management of severe bleeding under oral anticoagulation remains poor and might be improved by specific teaching program.