Introducing the “bleeding team”: Urgent reconstruction of an open fracture in a patient receiving acenocoumarol

Abstract

Case: An elderly, polytrauma patient receiving vitamin K antagonist (VKA) for atrial fibrillation required immediate surgery for open distal tibial fracture. As the initial reversal with vitamin K and fresh frozen plasma by the trauma team was ineffective, the “Bleeding Team” was convened and administrated the appropriate four-factor prothrombin complex regimen, reversing the VKA in a timely manner. Surgery was performed under peripheral nerve blockade subsequently. The postoperative course of the patient was uneventful. Conclusion: The individualized approach and the multidisciplinary experts’ team guidance is of outmost importance in patients who are treated with anticoagulants and present for nonelective surgery. © 2021 Lippincott Williams and Wilkins. All rights reserved.