The benefits of vitamin K antagonists (VKAs) have been widely demonstrated across numerous indications. Although their efficacy is well established, these drugs may lead to various complications, among which hemorrhagic events are the most frequent and severe. Acute gastrointestinal bleeding is one of the main presentations of VKA overdose.Identify predictive factors of mortality in patients admitted to the emergency department for upper gastrointestinal bleeding associated with VKA overdose.We conducted a prospective, single-center study over a one-year period (January 2023–January 2024). All patients admitted to the emergency department for upper gastrointestinal bleeding with documented VKA overdose were included. Epidemiological, clinical, biological, endoscopic, and therapeutic data were collected. A multivariate analysis was performed to determine independent predictors of in-hospital mortality.A total of 43 patients were included (mean age 71 ± 14 years; sex ratio 1.15). All received Sintrom for atrial fibrillation, valve replacement, deep vein thrombosis, or pulmonary embolism. Main comorbidities were hypertension, diabetes, coronary artery disease, and dyslipidemia. Presenting symptoms were hematemesis, melena, general deterioration, and abdominal pain. Hemodynamic instability at admission: SBP < 90 mmHg in 27%, DBP < 50 mmHg in 23%, HR > 100 bpm in 48%. Hemoglobin < 7 g/dL in 50%. Mean INR 11 ± 7, with 50% > 10. Endoscopy was performed in 60% of cases; peptic ulcer disease in 21%. In-hospital mortality was 14%. Univariate predictors of mortality: Blatchford score ≥ 14, norepinephrine use, urea > 16 mmol/L. Multivariate analysis: only Blatchford score ≥ 14 remained significant.Several scoring systems have been developed to assess the prognosis of this condition. The Blatchford score was found to be more predictive of clinical risk compared with the initial Rockall score, as well as more accurate in identifying the need for blood transfusion.Our study demonstrated that clinical assessment and simple biological parameters provide easily identifiable predictors of mortality at admission in patients presenting with upper gastrointestinal bleeding related to VKA overdose.