Pharmacology and Management of the Vitamin K Antagonists

Ansell, Jack; Hirsh, Jack; Hylek, Elaine M.; Jacobson, A.; Crowther, Mark; Palareti, Gualtiero

doi:10.1378/chest.08-0670

Cited by 1,863 publications

(605 citation statements)

References 358 publications

Supporting

Mentioning

547

Contrasting

Unclassified

Order By: Relevance

“…These findings, together with the improved safety profile of today's PCCs, suggest that PCCs should be considered preferable to FFP for emergency oral anticoagulant reversal. This is reflected in the latest British and American guidelines on the reversal of anticoagulation as well as other review articles [2,3,14,38]. …”

Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

See 1 more Smart Citation

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

View full text Add to dashboard Cite

Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

show abstract

Section: Comparing Pccs With Human Plasmamentioning

confidence: 99%

“…Today, PCCs are mainly used for the emergency reversal of oral vitamin K antagonist (VKA) therapy [2,3], although in the USA they are only approved for haemophilia. Bleeding is the most frequent complication of oral anticoagulation, causing considerable morbidity and mortality [4].…”

Section: Introductionmentioning

confidence: 99%

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

et al. 2011

View full text Add to dashboard Cite

show abstract

“…There is an overall consensus in favor of a bridging therapy prior to urgent cardioversion in patients with life‐threatening hemodynamic instability caused by new‐onset NVAF 8, 9, 10, 11, 12, 13. The recommendation in guidelines9, 10, 12 and summaries of product characteristics14, 15 is less clear for those with stable NVAF who do not require rapid anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

Short‐Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care

Bouillon¹,

Bertrand²,

Boudali³

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundSeveral studies have recently examined the risks of bleeding and of ischemic stroke and systemic embolism associated with perioperative heparin bridging anticoagulation in patients with nonvalvular atrial fibrillation. However, few studies have investigated bridging risks during vitamin K antagonist initiation in outpatient settings.Methods and ResultsA retrospective cohort study was conducted on individuals starting oral anticoagulation between January 2010 and November 2014 for nonvalvular atrial fibrillation managed in outpatient care and identified from French healthcare insurance. Bleeding and ischemic stroke and systemic embolism events were identified from the hospitalization database. Adjusted hazard ratios with 95% CI were estimated using Cox models during the first and 2 following months of anticoagulation. Of 90 826 individuals, 30% had bridging therapy. A total of 318 (0.35%) cases of bleeding and 151 (0.17%) ischemic stroke and systemic embolism cases were identified during the first month of follow‐up and 231 (0.31%) and 122 (0.16%) during the 2 following months, respectively. At 1 month of follow‐up, the incidence of bleeding was higher in the bridged group compared with the nonbridged group (0.47% versus 0.30%; P<0.001), and this increased risk persisted after adjustment for covariates (hazard ratio=1.60; 95% CI, 1.28–2.01). This difference disappeared after the first month of treatment (0.93; 0.70–1.23). No significant difference in the occurrence of ischemic stroke and systemic embolism was observed either at 1 month of follow‐up or later.ConclusionsAt vitamin K antagonist initiation for nonvalvular atrial fibrillation managed in ambulatory settings, bridging therapy is associated with a higher risk of bleeding and a similar risk of arterial thromboembolism compared with no bridging therapy.

show abstract

“…In contrast, an INR of 2.5 to 3.5 is recommended for patients with atrial fibrillation and mechanical valves in the aortic or mitral positions. 1,36 …”

Section: Clinical Risk Factors For Strokementioning

confidence: 99%

“… a For patients taking warfarin. b Female patients with sex alone being the only risk factor. c Based on reference 1. d Apixaban, dabigatran, rivaroxaban. e Includes hemodynamically significant rheumatic mitral stenosis or mitral valve prolapse. f Based on reference 36. g Includes tissue prosthesis in the mitral, tricuspid, aortic pulmonic positions. h Includes mechanical prosthesis in the mitral, tricuspid, aortic pulmonic positions. …”

Section: Key Pointsmentioning

confidence: 99%

Selecting antithrombotic therapy for patients with atrial fibrillation

Tanaka-Esposito

Chung

2015

CCJM

View full text Add to dashboard Cite

When considering anticoagulant therapy for patients with atrial fibrillation, one must balance the reduction in risk of thromboembolism that this therapy offers against the risk of bleeding that it poses. The American Heart Association, American College of Cardiology, and Heart Rhythm Society updated their atrial fibrillation guidelines in 2014. This review outlines a rationale for clinical decision-making based on the new guidelines and summarizes the currently approved drugs.

show abstract

Pharmacology and Management of the Vitamin K Antagonists

Cited by 1,863 publications

References 358 publications

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

Short‐Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care

Selecting antithrombotic therapy for patients with atrial fibrillation

Contact Info

Product

Resources

About