Managing Excessive Warfarin Anticoagulation
2001; American College of Physicians; Volume: 135; Issue: 6 Linguagem: Inglês
10.7326/0003-4819-135-6-200109180-00015
ISSN1539-3704
Autores Tópico(s)Venous Thromboembolism Diagnosis and Management
ResumoEditorials18 September 2001Managing Excessive Warfarin AnticoagulationHenry I. Bussey, PharmDHenry I. Bussey, PharmDClinical Pharmacy ProgramsDr. Bussey: San Antonio, TX 78229-3900Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-6-200109180-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Warfarin is very effective in preventing thromboembolic events, but it is probably one of the most dangerous drugs that is used on a long-term basis. Warfarin reduces the risk for stroke in atrial fibrillation by approximately 85%, but almost one half of eligible patients do not receive such therapy (1, 2). Apparently, many clinicians do not use warfarin for fear of bleeding complications.In this issue, Hylek and colleagues (3) provide valuable new information that should improve the ability to manage excessive warfarin anticoagulation and reduce risk for bleeding. Their review of 633 patients with excessive elevation of the international ...References1. . Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized, controlled trials. Arch Intern Med. 1994;154:1449-57. [PMID: 8018000] CrossrefMedlineGoogle Scholar2. Nilasena DS, Kreswik TF, Piskac AF, et al . National rates of warfarin use in Medicare patients with atrial fibrillation: results from the National Stroke Project [Abstract]. Stroke. 2001;31:328. CrossrefGoogle Scholar3. Hylek EM, Regan S, Go AS, Hughes RA, Singer DE, Skates SJ. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med. 2001;135:393-400. LinkGoogle Scholar4. Rosendaal FR, Cannegieter SC, van de, Meer FJ, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993;69:236-9. [PMID: 8470047] CrossrefMedlineGoogle Scholar5. Azar AJ, Cannegieter SC, Deckers JW, Briët E, van Bergen PF, Jonker JJ. Optimal intensity of oral anticoagulant therapy after myocardial infarction. J Am Coll Cardiol. 1996;27:1349-55. [PMID: 8626943] CrossrefMedlineGoogle Scholar6. . Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med. 1995;333:5-10. [PMID: 7776995] CrossrefMedlineGoogle Scholar7. Cannegieter SC, Rosendaal FR, Wintzen AR, van der Meer FJ, Vandenbroucke JP, Briët E. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med. 1995;333:11-7. [PMID: 7776988] CrossrefMedlineGoogle Scholar8. . A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. Ann Neurol. 1997;42:857-65. [PMID: 9403477] CrossrefMedlineGoogle Scholar9. Yamaguchi T. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation: a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. Stroke. 2000;31:817-21. [PMID: 10753981] MedlineGoogle Scholar10. Ansell J, Hirsh J, Dalen J, Bussey H, Anderson D, Poller L, et al . Managing oral anticoagulant therapy. Chest. 2001;119:22S-38S. [PMID: 11157641] CrossrefMedlineGoogle Scholar11. Hylek EM, Chang YC, Skates SJ, Hughes RA, Singer DE. Prospective study of the outcomes of ambulatory patients with excessive warfarin anticoagulation. Arch Intern Med. 2000;160:1612-7. [PMID: 10847254] CrossrefMedlineGoogle Scholar12. Bussey HI, Chiquette E, Bianco TM, Lowder-Bender K, Kraynak MA, Linn WD, et al . A statistical and clinical evaluation of fingerstick and routine laboratory prothrombin time measurements. Pharmacotherapy. 1997;17:861-6. [PMID: 9324174] MedlineGoogle Scholar13. Fairweather RB, Ansell J, van den Besselaar AM, Brandt JT, Bussey HI, Poller L, et al . College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: laboratory monitoring of oral anticoagulant therapy. Arch Pathol Lab Med. 1998;122:768-81. [PMID: 9740135] MedlineGoogle Scholar14. Weibert RT, Le DT, Kayser SR, Rapaport SI. Correction of excessive anticoagulation with low-dose oral vitamin K1 . Ann Intern Med. 1997;126:959-62. [PMID: 9182473] LinkGoogle Scholar15. Whitling AM, Bussey HI, Lyons RM. Comparing different routes and doses of phytonadione for reversing excessive anticoagulation. Arch Intern Med. 1998;158:2136-40. [PMID: 9801181] CrossrefMedlineGoogle Scholar16. Hirsh J, Dalen JE, Anderson DR, Poller L, Bussey H, Ansell J, et al . Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 1998;114:445S-469S. [PMID: 9822057] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Henry I. Bussey, PharmDAffiliations: Clinical Pharmacy ProgramsDr. Bussey: San Antonio, TX 78229-3900Corresponding Author: Henry I. Bussey, PharmD, Clinical Pharmacy Programs, MSC:6220, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Predictors of Prolonged Delay in Return of the International Normalized Ratio to within the Therapeutic Range after Excessive Anticoagulation with Warfarin Elaine M. Hylek , Susan Regan , Alan S. Go , Robert A. Hughes , Daniel E. Singer , and Steven J. Skates Metrics Cited byConventional Treatment of Deep Venous ThrombosisPreventing Warfarin-related BleedingCoumarin therapy in thrombosisCurrent AwarenessElevated INR: predictors of delay in normalisation 18 September 2001Volume 135, Issue 6Page: 460-462KeywordsAnaphylaxisHalf lifeHeart failureHemorrhageInternational normalized ratioProspective studiesResearch designResearch laboratoriesRetrospective studiesVitamin K ePublished: 18 September 2001 Issue Published: 18 September 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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