Prevention and treatment of bleeding complications in patients receiving vitamin K antagonists, Part 1: Prevention

Oral anticoagulant therapy with coumarins is widely used for the prevention and treatment of venous and arterial thrombosis. The most common complication of vitamin K antagonist therapy is bleeding, with major bleeding events occurring in 1-3% of patients annually. Although a number of potential predictors for bleeding have been described, little research is available to provide evidence-based guidelines for the prevention of bleeding. To address this knowledge gap, we assembled a panel of international experts and posed a series of focused clinical questions. The experts were asked to perform a systematic literature review and summarize the results of that review within the context of their clinical question. In many cases, data were lacking and the experts were asked to supplement their answer with clinical expertise. To minimize bias the reviews were vetted by three internationally recognized scholarly bodies. Our goal in this project is to provide "best evidence" for clinicians faced with the problem of minimizing the risk of bleeding in patients on vitamin K antagonist therapy.