Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism

Kovacs, Michael J.; Rodger, Marc; Anderson, David R.; Morrow, Brian; Kells, Gertrude; Kovacs, Judy; Boyle, Eleanor; Wells, Philip S.

doi:10.7326/0003-4819-138-9-200305060-00007

Cited by 196 publications

(145 citation statements)

References 12 publications

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“…4 There is conflicting evidence as to the optimal dose with which to initiate warfarin therapy. 53,54 An initial randomized trial found a 5-mg initial daily dose of warfarin as effective as 10 mg daily in achieving a therapeutic international normalized prothrombin time ratio within 5 days, with less tendency toward excessive anticoagulation. 53 In a more recent trial, involving only outpatients with VTE, 54 a 10-mg daily initial dose was more effective than 5 mg daily in achieving therapeutic anticoagulation (international normalized prothrombin time ratio 2.0 to 3.0) by the fifth day of therapy without excessive anticoagulation.…”

Section: Initiation Of Oral Anticoagulant Therapymentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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Abstract-Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention. Key Words: venous thromboembolism Ⅲ pulmonary embolism Ⅲ deep venous thrombosis Ⅲ anticoagulants Ⅲ thrombosis Ⅲ heparin

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Section: Initiation Of Oral Anticoagulant Therapymentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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“…Dosing algorithm was highly variable. 24,[31][32][33][34][35][36][37][38] Percentage TTR All studies but one 30 reported on this outcome, and all the studies except one used a standard linear interpolation method between successive INR values to calculate % TTR. 21 Hillman et al 25 did not report on the method used to calculate this variable.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Meta-analysis of Randomized Controlled Trials of Genotype-Guided vs Standard Dosing of Warfarin

Dahal

Sharma

Fung

et al. 2015

CHEST

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BACKGROUND:Warfarin is a widely prescribed anticoagulant, and its eff ect depends on various patient factors including genotypes. Randomized controlled trials (RCTs) comparing genotypeguided dosing (GD) of warfarin with standard dosing have shown mixed effi cacy and safety outcomes. We performed a meta-analysis of all published RCTs comparing GD vs standard dosing in adult patients with various indications of warfarin use.

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“…VTEs were diagnosed using previously published criteria. 34 The primary safety outcome was the occurrence of a major bleeding event (defined according to the International Society on Thrombosis and Haemostasis 35 ) during the period of administration of a nonheparin anticoagulant and up to 2 days after its discontinuation. We attempted to assess nonmajor bleeding events (defined as overt bleeding that did not meet the criteria for a major bleed, but were documented by any health professional); however, due to improper documentation, we were unable to do this.…”

Section: Study Outcomesmentioning

confidence: 99%

Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score–matched study

Kang

Alahmadi

Sawh

et al. 2015

Blood

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111

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Key Points• Fondaparinux seems to be an effective and safe alternative for the management of suspected HIT.Current guidelines for heparin-induced thrombocytopenia (HIT) management recommend heparin cessation and switching to a nonheparin anticoagulant (ie, argatroban, danaparoid) upon clinical suspicion. Fondaparinux may be effective but information supporting its use is limited. We retrospectively evaluated 239 patients who received a nonheparin anticoagulant (fondaparinux 5 133, danaparoid 5 59, and argatroban 5 47) for suspected or confirmed HIT. A propensity score was constructed based on age, gender, creatinine, 4T scores, and comorbidity index, and used to match 133 patients to 60 controls. Outcomes were thrombosis or thrombosis-related death and major bleeding. In the matched population there were 22 (16.5%) episodes of thromboses in the fondaparinux group and 13 (21.4%) in the control group (x 2 P 5 .424). Bleeding was observed in 28 (21.1%) patients in the fondaparinux group compared with 12 (20%) in the control group (x 2 P 5 .867). Survival analysis, and subgroup and unmatched analyses showed similar results. In the fondaparinux group, 60% of patients received prophylactic doses. Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists. (Blood. 2015;125(6):924-929)

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Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism

Abstract: The 10-mg warfarin initiation nomogram is superior to the 5-mg nomogram because it allows more rapid achievement of a therapeutic INR.

Cited by 196 publications

References 12 publications

Initial Treatment of Venous Thromboembolism

Initial Treatment of Venous Thromboembolism

Meta-analysis of Randomized Controlled Trials of Genotype-Guided vs Standard Dosing of Warfarin

Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score–matched study

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