Managing Oral Anticoagulant Therapy

Ansell, Jack; Hirsh, Jack; Dalen, James E.; Bussey, Henry I.; Anderson, David R.; Poller, L.; Jacobson, A.; Deykin, Daniel; Matchar, David B.

doi:10.1378/chest.119.1_suppl.22s

Cited by 519 publications

(401 citation statements)

References 149 publications

(151 reference statements)

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“…O controle laboratorial da anticoagulação dos pacientes em uso de anticoagulantes orais é realizado, classicamente, através da dosagem do tempo, e da atividade da protrombina 81 .…”

Section: Anticoagulantes Oraisunclassified

Diretriz de Embolia Pulmonar

Volschan¹,

Caramelli²,

Gottschall³

et al. 2004

Arq. Bras. Cardiol.

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“…O controle laboratorial da anticoagulação dos pacientes em uso de anticoagulantes orais é realizado, classicamente, através da dosagem do tempo, e da atividade da protrombina 81 .…”

Section: Anticoagulantes Oraisunclassified

Diretriz de Embolia Pulmonar

Volschan¹,

Caramelli²,

Gottschall³

et al. 2004

Arq. Bras. Cardiol.

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“…34 Intravenous heparin may be preferred for inpatients, whereas LMWH may be preferred for outpatients as it can be provided without monitoring.…”

Section: Drugs For Oral Anticoagulation Therapymentioning

confidence: 99%

“…Furthermore, its indirect mode of action, variable dose-response relationship, and sensitivity to drug-and dietinduced changes in absorption or metabolism complicate patient monitoring and dose adjustment. 31,34,47 Fixed-dose warfarin regimens do not achieve the desired therapeutic range. The SPAF III study, using fixed doses of warfarin (average dose of 2.0 mg/day, INR of 1.3), failed to show benefit because average INRs were below therapeutic levels.…”

Section: Drugs For Oral Anticoagulation Therapymentioning

confidence: 99%

The decision to anticoagulate: Assessing whether benefits outweigh the risks for patients with atrial fibrillation

Merli

Weitz

2004

Clinical Cardiology

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In a review of relevant articles from the Medline database on stroke risk in atrial fibrillation (AF) and adverse events related to anticoagulation treatment, we found that research to date shows a major potential benefit of warfarin therapy (International Normalized Ratio [INR] 2.0–3.0) for patients with AF (68% risk reduction in primary stroke prevention with warfarin vs. placebo). Despite this highly significant reduction in stroke risk, fewer than 50% of eligible patients are treated, in many cases because of fears of intracranial hemorrhage (ICH). The decision to implement anticoagulant therapy to improve outcome requires balancing the decreased risk for stroke against the increased risk for ICH. Various methods have been developed to define patient‐specific stroke risk. In contrast, risk for ICH strongly correlates with the intensity of anticoagulation, which is an unpredictable but controllable variable requiring frequent dose adjustments. Recent studies have also identified subgroups of patients with neurologic pathologies who are at increased risk for ICH. However, when the INR is properly controlled, the benefit from anticoagulation therapy for patients with AF and other risk factors for stroke exceeds the risk for ICH. Careful monitoring of anticoagulation and warfarin dose titration to maintain the INR between 2.0 and 3.0 is critical for reducing the risk for ICH, as is excluding patients with neurologic conditions that increase the likelihood of ICH. Future developments, such as the introduction of oral direct thrombin inhibitors with more predictable pharmacokinetics than warfarin, may further improve the benefit‐to‐risk ratio of anticoagulation therapy for patients with AF.

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“…Atrial fibrilation, cardiac valve diseases, deep venous thrombosis, cerebral and pulmonary emboli, and many other cardiovascular problems are among the most common indicators that the use of oral anticoagulants is required (Ansell, Hirsh, Dalen, Anderson and Deykin 2001;Hirsh, Fuster, Ansell and Halperin 2003;Jaff, McMurtry and Archer 2011). In addition to the scientific advancements, oral anticoagulant treatments have been widely used before and after the medical and surgical treatments, in order to prevent arterial venous thrombus.…”

Section: Introductionmentioning

confidence: 99%