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| |  ISTH: US Anticoagulation Clinics Underuse Vitamin K By Jill Stein Special to DG News
PARIS, FRANCE -- July 9, 2001 -- A substantial number of anticoagulation clinics in the United States underuse oral vitamin K in patients taking warfarin whose International Normalized Ratio (INR) values are above therapeutic levels. This finding was presented at the Eighteenth Congress of the International Society on Thrombosis and Haemostasis (ISTH) yesterday (July 8) in Paris, France. Data indicate that the clinics do not comply with the guidelines for vitamin K use developed at the American College of Chest Physician’s (ACCP’s) Fifth Consensus Conference on Antithrombotic Therapy, published in 1998, investigators say. Dr. David Garcia and associates, at the University of New Mexico in Albuquerque, New Mexico, United States, tested the hypothesis that the conference’s recommendations for vitamin K use are not routinely incorporated into clinical practice at anticoagulation clinics. They mailed surveys to 100 separate clinics in the southwestern US that are members of the Anticoagulation Forum, an association of anticoagulation clinic personnel and medical directors in the US and Canada. Respondents were presented with four scenarios involving asymptomatic patients taking warfarin whose INR was above therapeutic levels. In each scenario, the respondents were told the patient’s INR and whether or not the patient was at high risk of bleeding. Of 53 respondents, 13 (25 percent) reported that their clinics never use oral vitamin K. Eighteen (34 percent) stated that their clinics use subcutaneous vitamin K despite the absence of such a recommendation in the ACCP guidelines. For each scenario, the investigators made a judgment as to whether or not the respondent’s management was consistent with guidelines. Overall, only 14 (26 percent) respondents provided all four answers consistent with the ACCP recommendations. Dr. Garcia said that it is unlikely that the personnel running these clinics were not aware of the recommendations. At the time that the researchers conducted their survey, the recommendations had been in print for more than two years. They believe that many of the respondents based their management decisions on historical practice rather than the recommendations of experts or the latest evidence-based guidelines.
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