Academic literature on the topic 'Oral anticoagulant therapy'
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Journal articles on the topic "Oral anticoagulant therapy"
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HIRSH, Jack. "Oral Anticoagulant Therapy." Japanese Journal of Thrombosis and Hemostasis 5, no. 2 (1994): 114–20. http://dx.doi.org/10.2491/jjsth.5.114.
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MATSUDA, MAMORU. "Oral anticoagulant therapy." Nihon Naika Gakkai Zasshi 84, no. 9 (1995): 1523–27. http://dx.doi.org/10.2169/naika.84.1523.
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Brigden, Malcolm L. "Oral anticoagulant therapy." Postgraduate Medicine 91, no. 2 (February 1992): 285–96. http://dx.doi.org/10.1080/00325481.1992.11701213.
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Smithing, Robert T., and Madeline D. Wiley. "Oral Anticoagulant Therapy." Nurse Practitioner 20, no. 9 (September 1995): 70. http://dx.doi.org/10.1097/00006205-199509000-00011.
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Brigden, Malcolm L. "Oral anticoagulant therapy." Postgraduate Medicine 99, no. 6 (June 1996): 81–102. http://dx.doi.org/10.1080/00325481.1996.11946138.
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Raskob, Gary E. "Oral anticoagulant therapy." Current Opinion in Hematology 3, no. 5 (1996): 361–64. http://dx.doi.org/10.1097/00062752-199603050-00005.
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Ageno, Walter, Alexander S. Gallus, Ann Wittkowsky, Mark Crowther, Elaine M. Hylek, and Gualtiero Palareti. "Oral Anticoagulant Therapy." Chest 141, no. 2 (February 2012): e44S-e88S. http://dx.doi.org/10.1378/chest.11-2292.
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Agarwal, Pankaj. "Oral anticoagulant therapy." Indian Journal of Dental Research 23, no. 6 (2012): 836. http://dx.doi.org/10.4103/0970-9290.111278.
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Anand, A. "Oral anticoagulant therapy." Archives of Internal Medicine 153, no. 16 (August 23, 1993): 1933a—1933. http://dx.doi.org/10.1001/archinte.153.16.1933a.
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Anand, Ajay. "Oral Anticoagulant Therapy." Archives of Internal Medicine 153, no. 16 (August 23, 1993): 1933. http://dx.doi.org/10.1001/archinte.1993.00410160107011.
Full textDissertations / Theses on the topic "Oral anticoagulant therapy"
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Troulis, Maria J. "Dental extractions in patients receiving oral anticoagulant therapy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ37316.pdf.
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Cromheecke, Manon Elizabeth. "Safety management in mechanical heart valve replacement and oral anticoagulant therapy." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/57002.
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Nakano, Yukiko. "Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263518.
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Blaskowsky, Jeffrey, Adam Odeh, Tyler Stuntz, and Ali McBride. "Drug Therapy Interactions with New Oral Anticoagulants in Oncology Patients: a Retrospective Database Analysis 2013 - 2015." The University of Arizona, 2016. http://hdl.handle.net/10150/613993.
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Class of 2016 AbstractObjectives: To identify common and serious drug-drug interactions involving novel anticoagulant drugs in cancer patients. Subjects: 60 patients who were treated at the Banner University of Arizona Cancer Center between November 1, 2013 and April 1, 2015 with rivaroxaban, dabigatran, or apixaban. Methods: A retrospective chart review was performed for patients who received a NOAC (novel oral anticoagulant) to determine if a medication regimen contained a drug-drug interaction involving the NOAC. Results: When analyzing the DDIs involving rivaroxaban, dabigatran, and apixaban, Micromedex® detected a total of 123 interactions, compared to Lexicomp®, which detected 111 interactions. When using Lexicomp®, there were 59 (32%) instances of no detected interactions, 19 (10%) moderate interactions, 27 (15%) major interactions, and 65 (36%) contraindicated DDIs with rivaroxaban. When using Micromedex®, there were 47 (26%) instances where no interaction was detected, 4 (2%) moderate interactions, and 119 (65%) major interactions, and no interactions were classified as contraindicated with rivaroxaban. Lexicomp® detected 3 (50%) interactions as major, and found no DDIs in 3 (50%) instances for dabigatran, and detected 1 (7%) moderate, 2 (14%) major and 6 (43%) contraindicated interactions for apixaban. Micromedex® detected 3 (50%) interactions as major, and found no DDIs in 3 (50%) instances for dabigatran, and detected 12 (86%) of interactions as major and found no DDIs in 2 (14%) instances for apixaban. Conclusions: There was significant variation in DDI detection between current literature4,5 and the drug information databases, Lexicomp® and Micromedex®, however most interactions detected were major or contraindicated.
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Troulis, Maria J. "Dental extraction in patients receiving oral anticoagulant therapy." 1997. http://catalog.hathitrust.org/api/volumes/oclc/48237920.html.
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Hsieh, yuchen, and 謝佑偵. "The effect of dietary vitamin K on the stability of oral anticoagulant therapy." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/18922969646020479019.
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碩士輔仁大學
營養科學系
100
Up to half of the patients receiving anticoagulants failed to stabilize their status of blood coagulation within target range. Therefore, the risks of thromboembolism and bleeding increased in these patients. Dietary vitamin K has recently been recognized as a key factor that might interfere with long-term oral anticoagulation stability. This study assessed dietary vitamin K and cardiovascular disease (CVD)-protecting nutrients intake of Taiwanese patients receiving anticoagulation therapy. We evaluated whether the INR variability could be reduced and stability of anticoagulation control could be improved following instruction on the management on the daily intake of vitamin K. Patients anticoagulated with warfarin were recruited from the Neurology Clinic and Cardiology Clinic. We first validated a semi-quantitative food frequency questionnaire specifically designed to measure dietary vitamin K intake. Vitamin K FFQ (VK-FFQ) was administered at the beginning (VK-FFQ-1) and at the end (VK-FFQ-2) of one month. Four 24-hour dietary recalls (24hr) were collected between either two VK-FFQs. The average vitamin K intakes calculated from both four 24hr were used as the reference for VK-FFQ-1 and VK-FFQ-2 relative validity respectively. Vitamin K intake measured by the VK-FFQ-1 was significantly higher than that obtained by 24Hr. Secondly, dietary vitamin K intake of the anticoagulation patients in the study were assessed with the questionnaire. We provided patients counseling about green leafy vegetables intake and then evaluated the stability of anticoagulation therapy for unstable patients. The mean daily intake of vitamin K for stable and unstable patients were 738.0 ± 286.2 μg/d and 654.6 ± 580.0 μg/d, respectively. The results indicated the mean intake of vitamin K for patients approaching target INR (International Normalized Ratio) were 500-600 μg/d. The dietary intake of folate, magnesium, potassium and dietary fiber increased with the assistance of dietary counseling. Plasma concentrations of homocysteine and folate did not change during the study. In summary, the mean dietary intake of vitamin K in stable patients was higher than that that of unstable patients. Anticoagulation control and intake of CVD-protecting nutrients were improved in unstable patients receiving counseling on dietary vitamin K management.
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DANESE, Elisa. "VARIABILITY IN THE RESPONSE TO COUMARIN DRUGS AND CLOPIDOGREL: PHARMACOGENETIC EVALUATION AND CLINICAL IMPLICATIONS." Doctoral thesis, 2014. http://hdl.handle.net/11562/689359.
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Warfarin e clopidogrel rappresentano i farmaci più prescritti al mondo per il trattamento e la prevenzione del tromboembolismo arterioso. Nonostante la loro comprovata efficacia, entrambi i farmaci presentano un’elevata variabilità interindividuale sia in termini di risposta al trattamento che di tossicità. A causa di questa variabilità alcuni pazienti in terapia sono esposti ad un aumentato rischio di sanguinamento o di eventi trombotici. Al fine di rendere più sicuro ed efficace il trattamento con questi farmaci sono state individuate nuove strategie volte all’implementazione di una terapia anticoagulante ed antipiastrinica quanto più personalizzata.
Ad oggi, l’approccio più promettente per predire la dose di mantenimento di farmaci cumarinici è basato sull’utilizzo di algoritmi farmaco-genetici che includono dati sui polimorfismi a carico dei geni VKORC1 e CYP2C9, responsabili rispettivamente della farmacodinamica e farmacocinetica dei derivati cumarinici. Gli algoritmi attualmente validati sono in grado di prevedere fino al 80% della variabilità di risposta al warfarin. L’inclusione, all’interno di questi algoritmi di nuovi geni candidati, potrebbe ulteriormente migliorare la loro accuratezza predittiva. Studi recenti hanno dimostrato l’esistenza di forte associazione tra la dose giornaliera di warfarin necessaria per mantenere i valori di INR nel range terapeutico e il polimorfismo pV433M del gene CYP4F2.
La prima parte della tesi è incentrata sulla valutazione del ruolo di questa variante genica sulla dose media di coumarinici. La quantificazione dell’effetto è stata ottenuta attraverso una meta-analisi condotta su 30 studi e che ha coinvolto più di 9000 soggetti.
La seconda parte della tesi riguarda invece il monitoraggio della terapia con clopidogrel. L’attuale regime terapeutico consiste nella somministrazione di dosi predefinite di farmaco, anche se crescenti evidenze suggeriscono che la risposta ai test di funzionalità piastrinica è di valido aiuto nel predire l’efficacia del clopidogrel e nel guidare la terapia. Tra i diversi test oggi disponibili in commercio e maggiormente utilizzati nell’ambito della ricerca clinica, il VASP (test citofluorimentrico che valuta il grado di fosforilazione della proteina intracellulare VASP) potrebbe essere il miglior candidato per valutare l’efficacia dell’inibizione del recettore P2Y12. I risultati presentati in questa parte della tesi forniscono conferma del fatto che il VASP rappresenti il miglior predittore dell’attività antiaggregante piastrinica svolta in vivo dal clopidogrel. L’indice di reattività piastrinica misurabile con questo test riflette i livelli del metabolita attivo del clopidogrel rilevabili in vivo dopo somministrazione di una dose standard di carico. Il VASP sembra quindi rappresentare, nel trattamento antipiastrinico, l’equivalente del tempo di protrombina nella terapia anticoagulante orale.Highly effective treatment protocols have been designed for the management of cardiovascular diseases. However, large variability in clinical outcomes and frequent occurrence of adverse events have been observed, both attributed to the characteristics of some antithrombotic drug. Warfarin and clopidogrel are the most prescribed cardiovascular medications, highly effective in the treatment and prevention of arterial thromboembolism. However, both drugs show high variability as for efficacy, safety or dose requirement. Because of this variability, patients may be exposed to increased risk of bleeding and thrombosis. To minimize the risk, new strategies have been proposed, useful to design tailored anticoagulation and antiplatelet therapies. The most promising approach for predicting the maintenance dose of coumarins is the VKORC1 and CYP2C19 genotype-guided dosing protocol. Currently available algorithms can at most explain 80%, approximately, of the variablilby in the response to coumarins. Thus, efforts have been made to identify new candidate genes that could explain some of the missing variation and better inform coumarin dosing decisions. The CYP4F2 pV433M polymorphism has recently emerged as the most promising predictor of dose requirements. Its role in determining the mean daily dose has been evaluated through a meta-analysis involving more than 9000 treated subjects from thirty studies. Results are presented in the first chapter of this thesis. The second part of the thesis concerns achievements in the personalization of clopidogrel therapy. To date, treatment regimen is based on predefined doses, although the results of laboratory tests of platelet function represent the most promising way to predict the activity of clopidogrel in treated patients and to guide medical decision. Among different, commercially available tests, frequently used in clinical research, the VASP assay might represent the candidate “biochemical” gold standard for assessing the effectiveness of P2Y12-receptor blockade. Data presented here provides new steps towards the identification of the best predictor of the in vivo antiplatelet activity of clopidogrel. Evidence is given that the VASP assay (which measures the P2Y12-dependent inhibition by ADP of vasodilator-stimulated phosphoprotein, VASP) closely reflects the levels of clopidogrel active metabolite achieved in vivo. VASP phosphorylation can thus be considered for the treatment with P2Y12 antiplatelet agents as the equivalent of the prothrombin time used in the monitoring of anticoagulation therapy with coumarins.
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Farias, Maria de Fátima Cristóvão Filipe. "Percepção do estado de saúde de doentes com anticoagulação oral." Master's thesis, 2009. http://hdl.handle.net/10362/4471.
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RESUMO - O aumento da incidência das doenças crónicas representa um desafio enorme para todos os Sistemas de Saúde, pelo que a assistência de Saúde a doentes crónicos se tornou num problema das sociedades ocidentais. Os países mais pobres são os que mais sofrem, embora nos países desenvolvidos também se verifique um aumento notável das doenças crónicas. Estima-se que estas representem mais de 60% do total das doenças mundiais no ano 2020 (WHO, 2001). A adaptação dos actuais modelos de saúde aos doentes crónicos não atingiu os objectivos, o que conduziu a que, de há alguns anos a esta parte, se procure alternativas mais eficazes e eficientes. Uma das pressões do mercado que se fazem sentir será caracterizada por uma maior aposta na Promoção da Saúde e Prevenção da doença. O conceito de “Saúde” migrou de “não existência de doença” para “Bem-estar Físico e Psicológico”. Desta forma, o foco dos cuidados de saúde teve que ser adaptado, o que conduziu a uma situação em que o âmbito da prestação de cuidados de saúde é um contínuo de serviços que vai desde a promoção da saúde, medicina preventiva e medicina curativa aos cuidados continuados e cuidados paliativos. As tecnologias de informação e comunicação desempenharão um importante papel nesta tendência, permitindo estabelecer ligações contínuas entre os consumidores e prestadores de cuidados de saúde. Por outro lado, as potencialidades da Internet, das comunicações móveis, dispositivos portáteis e do instrumental electrónico, tornam-se evidentes no desenvolvimento de serviços de e-Saúde: para monitorização, seguimento e controlo dos doentes extra hospitalar - serviços estes centrados no doente. O objectivo geral do presente estudo consiste no desenho de um projecto de investigação para posterior avaliação da percepção do estado de saúde dos doentes seguidos na consulta de hipocoagulação do Hospital de Santa Marta. Devido à escassez de investigação na temática deste trabalho em Portugal, procedeu-se a um trabalho exploratório, descritivo, de carácter comparativo e enquadrado na abordagem quantitativa. O campo de análise consiste em comparar doentes que fazem anticoagulação oral, seguidos na consulta de cardiologia (consulta convencional), com os doentes seguidos no programa Airmed (através das comunicações móveis). 4 Para avaliação da percepção do estado de saúde foi utilizado o questionário SF-36.----ABSTRACT - The increasing incidence of chronic diseases represents an enormous challenge to the Health Systems and on cause of that, the Health Assistance to chronic patients became a concern of the Occidental society. The Countries with lower economical resources are the ones that suffers the most, but also the Developed countries have a noticeable increase of chronic diseases. It is estimated these will represent over 60% of total diseases world wide in 2020 (WHO,2001). The adaptation of the actual Health Models to chronic patients did not achieved it’s goals, what leaded to look for more effective and efficient alternatives. One of the more sensitive market pressure factor is to look for a better Health Promotion and Disease Prevention. The concept of “Health” merged from “Disease absence” to “Physic and Psychic Wellness”. In this way the Health Care focus had to be adapted, what drove to a status where the scope of the Health care is a continuum of services that goes from the Health Promotion, Preventive and Curative to Continued and Palliative Medical Care. The Information and Communication Technologies will play a crucial role in this trend, allowing to establish continued connections between patients and Health Care providers. In parallel the potential of the Internet, mobile communications, portable devices and electronic instruments became evident to deploy e-Health services: to monitor, follow-up and control of patients outside the Hospital. The overall objective of the present study is an Investigation Project Design to further evaluate the health status perception of the patients followed in the consultation for Hypocoagulation in the “Hospital de Santa Marta”. Due to lack of investigation in this thematic, in Portugal, this study is developed in an exploratory way, descriptive, comparative, within a scope of a quantified approach. The analysis field consists on comparing patients prescribed with oral anticoagulants and followed-up at the
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Celesner, Julie Madeleine Constance. "O atendimento médico-dentário a pacientes sob terapia antiagregante plaquetária ou anticoagulante oral – revisão narrativa." Master's thesis, 2020. http://hdl.handle.net/10284/9536.
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Contexto: Na atualidade, é cada vez mais comum a toma de antiagregantes plaquetários
e anticoagulantes. Tal situação leva a que, os médicos dentistas sejam confrontados
frequentemente com pacientes a tomar estes fármacos. Torna-se, assim, primordial o
conhecimento de recomendações baseadas na evidência que permitam o seu melhor
atendimento.
Objetivo: Descrever as condutas que devem ser adotadas pelos médicos dentistas para o
atendimento seguro dos pacientes em terapia antiagregante plaquetária ou anticoagulante,
baseando-se na literatura existente sobre o tema.
Metodologia: De acordo com o objetivo do trabalho, foi efetuada uma revisão
bibliográfica narrativa assente em artigos publicados em revistas disponíveis em diversas
bases de dados eletrónicas (B-on, PubMed e Cochrane), tendo sido também utilizadas
outras publicações com informação relevante.Background: Nowadays, it is increasingly common to take platelet antiaggregants and anticoagulants. This situation leads to dentists being frequently confronted with patients taking these drugs. It is therefore essential to be aware of evidence-based recommendations that allow for their best care. Objective: To describe the behaviors that should be adopted by dentists for the safe care of patients in platelet antiaggregant or anticoagulant therapy, based on the existing literature on the subject. Methodology: According to the objective of the work, a narrative bibliographic review was carried out based on articles published in several electronic databases (B-on, PubMed and Cochrane), and other publications with relevant information were also used.
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Rodrigues, Bruna Dinis. "Influência da complexidade terapêutica na adesão à terapêutica com Anticoagulantes Orais Diretos." Master's thesis, 2020. http://hdl.handle.net/10316/93034.
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Dissertação de Mestrado em Farmacologia Aplicada apresentada à Faculdade de FarmáciaA fibrilhação auricular é uma arritmia cardíaca crónica cuja prevalência aumenta com a idade e com a presença de comorbilidades. Estima-se que esta patologia seja responsável por cerca de 15% dos Acidentes Vasculares Cerebrais (AVCs) observados mundialmente. O tratamento de doentes com fibrilhação auricular tem como principal objetivo diminuir o riscode desenvolvimento de AVCs e tromboembolismo, assim como a taxa de mortalidade e morbilidade. Atualmente, os anticoagulantes orais diretos (DOACs) representam a primeira linha de tratamento na prevenção de AVC em doentes com fibrilhação auricular não valvular, dadas as suas vantagens face aos antagonistas da vitamina K (AVKs), nomeadamente o facto de não necessitarem de monitorização terapêutica. Uma taxa de adesão sub-ótima (<80%) por parte dos doentes sob terapêutica com DOACs continua a ser uma preocupação no que diz respeito à segurança e eficácia destes fármacos, na medida em que o efeito farmacológico é afetado negativamente com a falha de apenas uma toma. Um dos fatores que pode influenciar a adesão à terapêutica diz respeito àcomplexidade do regime terapêutico, perspetivando-se que quanto maior é a complexidade desse regime, menor será a adesão por parte do doente ao tratamento instituído. Por sua vez, vários fatores contribuem para a complexidade terapêutica, como o número de fármacos prescritos, o regime posológico e instruções de administração, contudo deve ter-se tambémem conta os fatores individuais dos doentes.Assim, o presente trabalho teve como principal objetivo avaliar a influência da complexidade terapêutica na adesão à terapêutica com DOACs em doentes diagnosticados com fibrilhação auricular não valvular e que tivessem sofrido eventos clinicamente significativos durante esse tratamento, como AVCs e hemorragias. A análise da complexidade terapêutica foi feita a 88 doentes, seguidos no Serviço de Cardiologia do Centro Hospitalar e Universitário de Coimbra, EPE (CHUC), com base no cálculo do Índice de Complexidade do Regime Terapêutico (do inglês, Medication Regimen Complexity Index, MRCI). Por sua vez, a adesão à terapêutica foi avaliada através da aplicação do Brief Medication Questionnaire aos doentes atualmente ainda em condições para responderem ao questionário (n=32).Os resultados obtidos revelaram uma população em estudo envelhecida (84,97 ± 6,79 anos), polimedicada (9,60 ± 3,08 fármacos) e com múltiplas comorbilidades (4,95 ± 2,31 comorbilidades). A taxa de adesão obtida pelos doentes em estudo foi de 34%, o que representa uma adesão sub-ótima. Para além disso, o valor de MRCI obtido no grupo de doentes não aderentes (30,53 ± 8,63) é superior face ao valor obtido no grupo de doentes aderentes (26,04 ± 10,54), sugerindo uma associação entre um regime terapêutico mais complexo e a não adesão à terapêutica. O número de fármacos presentes no regime terapêutico demonstrou estar fortemente associado ao aumento do MRCI (r=0,93) e a idade avançada influenciou negativamente a complexidade terapêutica (MRCI>85 anos= 29,88 ± 11,51). O regime terapêutico bidiário demonstrou ter maior complexidade e menor adesão à terapêutica face ao regime unidiário, sendo o dabigatrano o DOAC com menor taxa de adesão (14,29%) e o apixabano o DOAC associado a maior valor de MRCI (32,51 ± 10,62).Assim, de forma a potenciar a adesão à terapêutica, é importante ter em conta e adequar o regime terapêutico às caraterísticas individuais dos doentes, diminuindo a complexidade terapêutica, tal como proposto na presente dissertação.
Atrial fibrillation is a chronic cardiac arrhythmia. It’s prevalence increases with age and with the presence of comorbidities. It is estimated that atrial fibrillation is responsible for about 15% of the strokes observed worldwide. The main objective of treating patients with atrial fibrillation is to decrease the risk of developing strokes and thromboembolism, as well as the mortality and morbidity rates. Currently, direct oral anticoagulants (DOACs) represent the first-line of treatment in stroke prevention in patients with non-valvular atrial fibrillation given their advantages over vitamin K antagonists (VKAs), namely the fact that they do not need monitoring.A sub-optimal adherence rate (<80%) by patients taking DOACs remains a concern regarding the safety and efficacy of these drugs, as the pharmacological effect is negatively affected by the failure of just one administration. One of the factors that can influence adherence is medication regimen complexity. A higher regimen complexity is expected to decrease patient’s adherence to the treatment. Furthermore, several factors contribute to medication regimen complexity, such as the number of drugs prescribed, the dosage regimen and administration instructions, however the individual factors of the patients must also be taken into account.Thereby, the present study aimed to evaluate the influence of medication regimen complexity on adherence to DOAC therapy in patients diagnosed with non-valvular atrial fibrillation and who had suffered clinically significant events during this treatment (e.g. strokes or bleedings). The analysis of the medication regimen complexity was performed on 88 patients, followed at the Cardiology Service of the University’s Coimbra Hospital (CHUC), based on the calculation of the Medication Regimen Complexity Index (MRCI). In turn, adherence to therapy was assessed by applying the Brief Medication Questionnaire to patients currently available to answer the questionnaire (n=32).The results revealed an aging population (84.97 ± 6.79 years), polymedicated (9.60 ± 3.08 drugs) and with multiple comorbidities (4.95 ± 2.31 comorbidities). In the study, patient’r adherence was 34%, representing a sub-optimal adherence. In addition, the MRCI value obtained in the group of non-adherent patients (30.53 ± 8.63) was higher than the valueobtained in the group of adherent patients (26.04 ± 10.54), suggesting an association between a more complex therapeutic regimen and non-adherence. The number of drugs present in the therapeutic regimen was strongly associated with the increase of MRCI (r=0.93) and advanced age negatively influenced the therapeutic complexity (MRCI>85 years= 29.88 ± 11.51). The twice daily regimen was shown to have greater complexity and less adherence to therapy compared to the once daily regimen. Dabigatran was the DOAC with the lowest adherence rate (14.29%) and the therapeutic regimen with apixaban the highest associated MRCI value (32.51 ± 10.62).Therefore, in order to enhance adherence it is important to take into account and adapt the medication regimen to the individual characteristics of patients, as proposed in this dissertation.
Books on the topic "Oral anticoagulant therapy"
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Shepherd, P. C. A. Initiation of oral anticoagulant therapy in two hospitals in Lothian. [Edinburgh]: Scottish Office, 1994.
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E, Ansell Jack, Oertel Lynn B, and Wittkowsky Ann K, eds. Managing oral anticoagulation therapy: Clinical and operational guidelines. Gaithersburg, Md: Aspen Publishers, 1997.
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Anticoagulanti, Federazione Centri Sorveglianza. Haemostasis: A Guide to Oral Anticoagulant Therapy (Haemostasis). S Karger Pub, 1998.
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Provan, Drew, Trevor Baglin, Inderjeet Dokal, and Johannes de Vos. Haemostasis and thrombosis. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199683307.003.0010.
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Assessing haemostasis - The coagulation system - Laboratory tests - Platelets - Bleeding - Bleeding: laboratory investigations - Bleeding: therapeutic products - von Willebrand disease - Haemophilia A and B - Rare congenital coagulation disorders - Congenital thrombocytopenias - Congenital platelet function defects - Congenital vascular disorders - Haemorrhagic disease of the newborn - Thrombocytopenia (acquired) - Specific thrombocytopenic syndromes - Disseminated intravascular coagulation - Liver disease - Renal disease - Acquired anticoagulants and inhibitors - Treatment of spontaneous FVIII inhibitor - Acquired disorders of platelet function - Henoch–Schönlein purpura - Perioperative bleeding and massive blood loss - Massive blood loss - Heparin - Heparin induced thrombocytopenia/with thrombosis (HIT/T) - Oral anticoagulant therapy (warfarin, VKAs) - New oral anticoagulant drugs - Thrombosis - Risk assessment and thromboprophylaxis - Example of VTE risk assessment - Heritable thrombophilia - Acquired thrombophilia - Thrombotic thrombocytopenic purpura (TTP) - Haemolytic uraemic syndrome (HUS) - Heparin-induced thrombocytopenia (HIT)
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Provan, Drew, Trevor Baglin, Inderjeet Dokal, Johannes de Vos, and Angela Theodoulou. Haemostasis and thrombosis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199683307.003.0010_update_001.
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Assessing haemostasis - The coagulation system - Laboratory tests - Platelets - Bleeding - Bleeding: laboratory investigations - Bleeding: therapeutic products - von Willebrand disease - Haemophilia A and B - Rare congenital coagulation disorders - Congenital thrombocytopenias - Congenital platelet function defects - Congenital vascular disorders - Haemorrhagic disease of the newborn - Thrombocytopenia (acquired) - Specific thrombocytopenic syndromes - Disseminated intravascular coagulation - Liver disease - Renal disease - Acquired anticoagulants and inhibitors - Treatment of spontaneous FVIII inhibitor - Acquired disorders of platelet function - Henoch–Schönlein purpura - Perioperative bleeding and massive blood loss - Massive blood loss - Heparin - Heparin induced thrombocytopenia/with thrombosis (HIT/T) - Oral anticoagulant therapy (warfarin, VKAs) - New oral anticoagulant drugs - Thrombosis - Risk assessment and thromboprophylaxis - Example of VTE risk assessment - Heritable thrombophilia - Acquired thrombophilia - Thrombotic thrombocytopenic purpura (TTP) - Haemolytic uraemic syndrome (HUS) - Heparin-induced thrombocytopenia (HIT)
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Sinnaeve, Peter, and Frans Van de Werf. Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0044.
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Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.
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Sinnaeve, Peter, and Frans Van de Werf. Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0044_update_001.
Full textAbstract:
Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.
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Managing Oral Anticoagulation Therapy, Supplement 4. UNITED NATIONS, 2001.
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(Editor), Jack E. Ansell, Lynn B. Oertel (Editor), and Ann K. Wittkowsky (Editor), eds. Managing Oral Anticoagulation Therapy: Clinical and Operational Guidelines. 2nd ed. Facts and Comparisons, 2002.
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McDonald, Vickie, and Marie Scully. Anticoagulants and antithrombotics in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0051.
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Coagulation is best thought of using the cell-based model of coagulation. Patients commenced on heparin therapy should have their platelet count monitored early because of the risk of heparin-induced thrombocytopenia, which can occur on any type or dose of heparin. Emergency reversal of warfarin should be with prothrombin complex concentrate (containing factors II, VII, IX, and X) and not fresh frozen plasma. New oral anticoagulants have the advantage of predictable pharmacokinetics and do not require routine monitoring, but optimal reversal strategies for these agents are not clear. Thrombolytic agents lead to variable degrees of systemic lysis, which may cause haemorrhage, including intracerebral haemorrhage
Book chapters on the topic "Oral anticoagulant therapy"
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Parra, David, and Michael Brenner. "Concerns with Anticoagulant Adherence." In Oral Anticoagulation Therapy, 37–42. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_7.
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Tripodi, A. "Monitoring Oral Anticoagulant Therapy." In Quality in Laboratory Hemostasis and Thrombosis, 179–89. Oxford, UK: Wiley-Blackwell, 2009. http://dx.doi.org/10.1002/9781444303575.ch18.
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Beavers, Craig J. "Patient on Oral Anticoagulant Presenting with ACS." In Oral Anticoagulation Therapy, 167–72. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_24.
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Beavers, Craig J. "Oral Anticoagulant Therapy Post-Percutaneous Coronary Intervention." In Oral Anticoagulation Therapy, 173–79. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_25.
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Burkhart, Jena I. "Choosing an Anticoagulant in an Elderly Patient." In Oral Anticoagulation Therapy, 19–24. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_4.
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dela Pena, Lea E. "Anticoagulant Drug-Drug Interactions with CYP 3A4 Inhibitors." In Oral Anticoagulation Therapy, 195–99. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_28.
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Beavers, Craig J. "ST-Segment Elevation Myocardial Infarction (Lytic Candidate) on Oral Anticoagulant." In Oral Anticoagulation Therapy, 181–85. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54643-8_26.
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Abdeladim, Salma, Mahassine Elharrass, Ilham Bensahi, Amal Elouarradi, and Mohamed Sabry. "Oral Anticoagulant Therapy in the Arab World." In Handbook of Healthcare in the Arab World, 1–27. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-319-74365-3_194-1.
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Warwick, David, and David Gozzard. "Thromboprophylaxis in patients on oral anticoagulant therapy." In Handbook of Thromboprophylaxis, 53–58. Tarporley: Springer Healthcare Ltd., 2011. http://dx.doi.org/10.1007/978-1-908517-00-5_8.
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Abdeladim, Salma, Mahassine Elharrass, Ilham Bensahi, Amal Elouarradi, and Mohamed Sabry. "Oral Anticoagulant Therapy in the Arab World." In Handbook of Healthcare in the Arab World, 2871–96. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-36811-1_194.
Full textConference papers on the topic "Oral anticoagulant therapy"
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Rouvier, J., H. Vidal, J. Gallino, M. Boccia, A. Scazziota, and R. Altman. "ACUTE INTERRUPTION OF ORAL ANTICOAGULANT THERAPY: A THROMBOTIC RISK?" In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643265.
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It is still on discussion how oral anticoagulant therapy must be interrupted. A progressive diminution of drug intake have been proposed in order to avoid a MreboundM of vitamin K-dependent procoagulant factors. At the present, it is well known that coumarin drugs affect not only the biologic activity of factors II, VII, IX and X but also Protein C (PC), an inhibitor of coagulation kinetics, and their cofactor Protein S. With the aim to determine the recovery level of PC in relation with the others vitamin K-dependent factors, the effect of suppression of anticoagulant therapy in patients under chronic treatment with acenocoumarin was studied.Quick time, functional factors II, VII, X (one stage methods), functional PC (Francis method) and immunological Factor II and Protein C (Laurell) were determined before and 36 hours after suspension of acenocoumarin administration.Results showed that: 1) Recovery levels of functional Protein C (increased from 28.55% ±2.57 to 72.64% ±5.9) were significantly higer than functional Factor II (22.09% ±2.34 to 30.73% ±8.64), Factor VII (22.55% ±2.01 to 40.73% ±4.85) and Factor X (23.27% ±2.66 to 39.18% ±3.19). Statistical analysis (Newmann-Keuls test) showed at least a p<0.01 between PC increase and factors II, VII or X increment.2) No significant differences were seen between immunological levels of Factor II before and after suspension of acenocoumarin.3) Levels of immunological PC in patients under anticoagulant therapy were higer than functional PC. After acenocoumarin suppression, not correlation was seen between immunological and functional Protein C recovery.It is concluded that acute suppression of acenocoumarin does not induce a thrombotic tendency because the recuperation of functional Protein C is more important than factors II, VII and X recovery.
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Hull, Russell D., and Gary E. Raskob. "TREATMENT OF DEEP VENOUS THROMBOSIS AND ECONOMIC ASPECTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642968.
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Initial therapy with intravenous heparin, followed by long-term anticoagulant therapy for three months or more, is the treatment of choice for most patients with acute venous thrombosis. Inferior vena caval interruption, using a transvenously inserted filter, is the management of choice for preventing pulmonary embolism in patients in whom anticoagulant therapy is contraindicated, and in the very rare patient in whom anticoagulant therapy is ineffective. The role of thrombolytic therapy has not been completely resolved. It was hoped that thrombolytic therapy would minimize or prevent the post-phlebitic syndrome; unfortunately, this may not be the case because the critical factor in the development of the post-phlebitic syndrome appears to be venous valve damage, which occurs early in the formation of venous thrombosis. Thrombolytic therapy should be considered in selected patients with acute massive venous thrombosis (eg. the patient with phlegmasia cerulea dolens).Intravenous heparin administered in doses which prolong the activated partial thromboplastin time (APTT) to 1.5 to 2 times control is highly effective and is associated with a low frequency (2%) of recurrent venous thromboembolism. A recent randomized trial (1) in patients with proximal-vein thrombosis indicates that failure to achieve an adequate anticoagulant response (APTT > 1.5 times control) is associated with a high risk (20%) of recurrent venous thromboembolism. Therefore, sufficient heparin should be administered to maintain the APTT above 1.5 times the control value.Intravenous heparin is continued for 7 to 10 days, overlapped with oral anticoagulant therapy for 4 to 5 days before heparin is stopped. Multiple randomized clinical trials in patients with proximal-vein thrombosis indicate that when heparin is administered for 7 to 10 days, followed by adequate long-term anticoagulant therapy, the frequency of recurrent venous thromboembolism is very low (2%). An alternative approach is to commence heparin and oral anticoagulants together at the time of diagnosis, and to discontinue heparin on the fourth or fifth day. If this latter approach is effective, it would avoid 4 to 5 days of unnecessary hospitalization in many patients, and would markedly reduce the cost of initial heparin therapy. A recent randomized trial (2) in patients with submassive venous thromboembolism suggests that 4 to 5 days of initial heparin therapy is effective and safe, but this approach must be evaluated by further randomized clinical trials before it is routinely recommended.Recent clinical trials indicate that inadequate long-term therapy in patients with proximal-vein thrombosis results in a high frequency (40-50%) of recurrent venous thromboembolism and is cost-ineffective because of the diagnostic and treatment costs of recurrent venous thromboembolism (3). The risk of recurrence is markedly reduced to 2% by adequate long-term anticoagulant therapy with warfarin sodium or adjusted subcutaneous heparin; both of these approaches are markedly more cost-effective than inadequate long-term therapy (3). Oral anticoagulant therapy with warfarin sodium for three months (or longer in selected patients), is less expensive than adjusted subcutaneous heparin and is preferred in most patients with acute proximal-vein thrombosis. The risk of bleeding associated with oral anticoagulant therapy can be reduced to less than 5%, without loss of effectiveness for preventing recurrent venous thromboembolism, by adjusting the dose of warfarin sodium to achieve a less intense anticoagulant effect (PT 1.25 to 1.5 times control using a rabbit brain thromboplastin such as Simplastin or Dade-C, corresponding to an INR of 2.0 to 3.0). Less intense warfarin sodium therapy is the most cost-effective of the alternative long-term anticoagulant regimens (3). Adjusted dose subcutaneous heparin is an effective and safe alternative to warfarin sodium; although slightly more expensive, it is the long-term regimen of choice in pregnant patients, and in patients returning to geographically remote areas lacking the facilities for anticoagulant monitoring (in whom the dose is adjusted during the first few days of long-term therapy and then fixed). REFERENCES: (1) Hull R, Raskob G, Hirsh J et al. N Engl J Med 1986;315:1109-1114. (2) Gallus A, Jackaman J, Tillett J et al.Lancet 1986;2:1293-1296. (3) Hull R, Raskob G, Hirsh J, Sackett DL. JAMA 1984;252:235-239.
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Brien, W., M. Inwood, and K. Dillon. "QUALITY ASSURANCE OF THERAPEUTIC HEPARIN/ORAL ANTICOAGULANT THERAPY IN A GENERAL TEACHING HOSPITAL." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644170.
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In preparation for the development of a standard anticoagulation protocol and as part of a quality assurance programme, a retrospective analysis of anticoagulation therapy in a teaching hospital was undertaken. The results of this audit were compared to the results of other workers who have previously emphasized controversial areas of anticoagulation therapy and potential benefits of a standard anticoagulation protocol.Charts from seventy-nine patients with a diagnosis of venous thrombosis were analyzed. Fifty-five percent of the patients were at increased risk of bleeding and forty-five percent had an extensive proximal vein thrombosis, but not apparent consideration of a heparin dose adjustment was noted. Patients received heparin for an average 9.7 days, with concomitant coumadin therapy for an average 4.8 days. Patients on heparin were over/ or undercoagulated on average 5.4 days and ninety-four percent of patients on coumadin had a PT (rabbit brain) greater than 18 seconds for at least one day. Sixty percent of patients had their dose changes noted in a tabular form for easy reference. Less than fifty percent had their hemoglobin or platelet counts followed while on heparin. The APTT and TCT are used to follow heparin therapy and discrepant results were noted in thirty-three percent. All patients' discrepancies were investigated automatically by the coagulation laboratory. Less than thirty percent of patients received formal teaching from the clinical pharmacist concerning coumadin therapy.We feel that these results show a need for a standard protocol for heparin coumadin therapy. It has been shown that a standard protocol favourable chemical, financial and therapeutic benefits
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Palmieri, G., R. Palmieri, G. Ambrosi, R. Ferraro, L. Bucci, and A. M. Agarthi. "DEFIBROTIDE VS. HEPARIN IN ACUTE THROMBOFLEBITIS THERAPY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643145.
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Defobrotide(D) a natural polydeoxyribonucleotide of mammalian lung origin is a new substance with no anticoagulant or hemodinamic effects?it has shown considerable profibrinolytic and antithrombotic activities. The ability of (D) to increase generation of prostaci-clmCPGI2) from vascular tissue has been demonstrated; this substance also promotes substantial release from vascular tissues of a plasminogen activator factor which plays an important role in preventing thrombotic oclusion of vascular segments.Widely accepted therapies in deep venous thrombosis and Acute Thromboflebitis (A.f.; are based on anticoagulant treatments (heparin and/or oral anticoagulant agentsWe have evaluated the efficacy of (D> in (A.T.) vs. heparin in 40 pts.(28 females 12 males;mean age=50) with an open randomized study.Group A:20 pts.have been administered CD; 200mg.four times a day l.m. for 10 days.Group B:20 pts.have been administered Sodic Heparin 30000 U.I. intravenously with successive dosage based upon APTT values.Both groups have been treated with an oral anti coagulant agentCacenocoumaro1) after the tenth day.No clinical differences between the treatments have been observed and in no pts. treated with CD; we noted significant changes m laboratory parameters evaluated: complete blood count,glycemia BUN creatinine ALT AST LDH.Clinical eficacy was excellent in both groups also supported by augmented fibrinolysis and instrumental improvement(strain-gauge plethismography;.The absolute safety of (D> therapy shows its possible alternative role when compared to heparin treatment in (A.T.> of any origin.
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Mukhlova Montiel, M., and H. Bussey. "RESPONSE OF PROTEIN C AND PROTEIN S INHIBITORS IN LONG-TERM ORAL ANTICOAGULANT THERAPY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643877.
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Protein C (PC) and its coenzyme Protein S (PS) are physiologic inhibitors of activated factors Va and Villa. Deficiency of either one of these inhibitors has been associated with venous thrombosis. Their activity is dependent on vitamin K for hepatic gamma carboxylation and it is depressed during oral anticoagulant therapy. Because rebound thrombosis complicates cessation of anticoagulant therapy, we investigated the response of PC and PS during long term oral anti coagulation. The study encompassed 30 patients ranging between 26 and 76 years of age, who have received therapeutic doses of coumadin from 15 days to more than 8 years. The conditions for which treatment was initiated were deep vein thrombosis, cerebral vascular accidents and cardiac valve replacements.Factor VII and X activity was assayed by one step routine clotting assays. PC antigen (ag), total PSag and free PSag were assayed by Laurel 1 Rocket electroimmunodiffusion method. The measurement of the free PS was carried out after precipitation of C4b-binding protein with polyethylene glycol. PC activity was measured by clotting assay using PC deficient plasma to which was added patient plasma as a source of PC. Control group of 30 individuals in similar age group were assayed parallel with the patient samples. Compared with the control group the coumadin-treated patients showed substantial decrease of all factors studied. Statistical regression analysis of the coumadin group showed a significant increase in PS free (p = 0.014)during long term anti coagulation, while all of the other variables did not change significantly.PCag and total PSag were decreased and their activities, as expected, were more severely affected. The ratio of PC activity to PCag averages 0.39 (normal >0.80) and free PS represented only 27% of the total PSag (normal about 40%). The inhibitors' persistent activity parallels that of the depression of Factors VII and X and there appears to be a balanced coagulation-inhibi-tion system. If PC and PS play a role in rebound thrombosis after a prolonged anticoagulation therapy, the changes may occur after discontinuation of medication.
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Sagripant, A., A. Carpi, U. Baicchi, A. Nicolini, and M. Ferdeghint. "ORAL ANTICOAGULANTS IN BREAST CANCER PATIENTS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643671.
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As the fibrin clot may play a role in the intravascular metastatic spread of breast cancer, we have treated women with advanced breast cancer with oral anticoagulants. After mastectomy, 11 consentient women with postsurgical stage Nl (6 patients), N2 (3 patients) and N3 (2 patients) and without evidence of distantmetastasis have been treated with acenocoumarol (INR 2-4,5) for 4-22 months (mean 12 months). All the patients received adjuvant therapy (radiotherapy, polichemiotherapy and/or tamoxifen) in conformity with theclassic indications. FibrinopeptideA plasmatic level, checked in everyone on stable anticoagulation, was always lower than 2 ng/ml (mean 0,78 ng/ml). No major bleeding occurred, except a copious hematuria caused by overdosage. Until now all the 11 women are alive. Two of them stopped anticoagulant, one because of hemorrhagic cystitis, the other because of awareness of visceral metastases; all the other 9 women arebeing treated now. Three patients(2N2 and 1 N3) have evidence of visceral metastases; no sign of relapsehas been observed by serial instrumental and laboratory examinations inthe other 8 women. A control group of 13 patients (9 N2 and 4 N3)was compared with the group of anticoagulated patients in more advanced stages (2 N2 and 3 N3):The follow-up of the anticoagulatedNl patients is too brief as yet forcomparative evaluation. Our preliminary data seem to indicate an useful role of oral anticoagulants inbreast cancer and oblige us to prolong investigation.
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Marques, Marina Trombin, Leonardo de Sousa Bernardes, Rafael Zini Moreira da Silva, Matheus Gonçalves Maia, Edson Junior Gonçalves Bechara, Eduardo dos Santos Sousa, Juliana Rodrigues Dias Primo, Vivian Dias Baptista Gagliardi, and Rubens José Gagliardi. "Trousseau Syndrome in a patient on Direct Oral Anticoagulant use: A Case Report." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.508.
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Background: The Three Territory Sign (TTS) is a radiologic marker of ischemic stroke associated with malignant neoplastic diseases (Trousseau Syndrome) and corresponds to a rare stroke etiology. Case Report: Female, 62-year-old patient, with comorbidities of smoking, hypertension and diabetes, presented with a sudden faciobrachial-predominant left hemiparesis settled in the day before the admission. Diagnosed with a metastatic rectal adenocarcinoma seven months before, she underwent a rectosigmoidectomy three months ago and developed deep vein thrombosis, starting anticoagulant therapy with rivaroxaban 20mg daily. A Magnetic Resonance Imaging (MRI) revealed several lesions with restricted diffusion in multiple vascular territories, bilaterally, corresponding to ischemic stroke. Etiologic investigation did not detect signs of cardioembolism, nor significant vessel stenosis or unstable atherosclerotic plaques. In admission, she had a D-dimer level of 11,43μg (0- 0,5μg/mL). Conclusion: The evidence of TTS is about six times more frequent in stroke related to malignancies compared to cardioembolic etiology. The D-dimer is a marker of malignancies in cryptogenic stroke, elevated in 75% of cases. The most common associated neoplasms are pulmonary (40%) and gastrointestinal (33,3%). In the MRI, the lesions can be isolated or gathered, generally small and peripheral. There is no evidence regarding the ideal preventive therapy. It is necessary to reinforce the importance of investigating malignancies in patients presenting with cryptogenic stroke and TTS, a syndrome that is still poorly recognized.
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Pengo, V., M. Boschello, P. Peruzzi, D. Pagotto, L. Schivazappa, and S. Dalla Volta. "PATIENTS WITH ARTIFICIAL BUT NOT BIOLOGICAL HEART VALVE PROSTHESIS PRESENT A HYPERCOAGULABILITY RELATED TO THE INTENSITY OF ANTICOAGULATION." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643878.
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Long term anticoagulant therapy is mandatory for patients with artificial heart valve prosthesis and is suggested for some patients with biological heart valve prosthesis. Oral anticoagulants reduce but not abolish thromboembolic complication in these patients. They act lowering the level of vitamin K-dependent coagulation factors and that in turn should result in a depression of "in vivo" thrombin formation. Fibrinopeptide A (FpA) is a good marker of thrombin formation and therefore we ascertained in several occasions the thrombin formation in 43 patients with artificial and 18 with biological heart valve prosthesis, all the patients being on oral anticoagulant treatment at least from 1 year. FpA was significantly higher in patients with artificial (determinations n = 138) with respect to biological (n=73) heart valve prosthesis (p 0.01). The FpA level in biological valves was close to that obtained in 22 not anticoagulated healthy subjects. When we divided FpA values in artificial heart valves according to the intensity of anticoagulation, we obtained a decreasing FpA mean levels with the increase of the degree of anticoagulation. In particular FpA values with an INR 4.5 were close to values obtained in healthy subjects. These data support the concept that patients with artificial heart valves are at higher risk of thromboembolism and therefore the intensity of anticoagulation should be different with respect to biological valves and probably a little higher than that recommended at the Leuven Consensus Conference.
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Taberner, D. A., J. M. Thomson, and L. Poller. "COAGULATION, FIBRINOLYSIS AND PLATELET FUNCTION DURING COUMARIN THERAPY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643274.
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The inactivation of factors VIII:C, V:C and fast acting TPA inhibitor by activated Protein C indicates that oral anticoagulation is more than simple reduction of prothrombin complex activity. To investigate these changes, six patients were studied after stopping oral anticoagulant treatment. Protein C activity and C antigen, Factors VIII:C, VIII:vWFAg, V:C, V:Ag, X:C, VII:C, fibrinogen and TPA activity were measured during long-term nicoumalone therapy (duration of therapy 8-96 months, mean 28 months), and after discontinuation on days 2, 4, 8, 10, 15, 30 and 42.The INR on the last day of therapy ranged between 2.0 - 3.3, (mean 2.6). Protein C activity and antigen and factor X became normal by day 8; factor II by day 10. Factor VII activity peaked on day 8, falling to resting levels by day 30. Factor VIII parameters remained high throughout, whereas Factor V antigen showed no significant change. Factor V activity was not quantifiable untill day 8 because of non-parallelism (? PIVKA effect), but was higher on day 8 than day 42 (p < 0.002 paired “t” test) . The higher levels of factor V activity could be protein C dependent, but the high factor VIII appears unrelated. Fibrinogen levels were higher on coumarin treatment (p < 0.05 paired “t” test) and took 30 days to fall to resting level. The effect of Protein C on TPA inhibitor would be expected to increase the activity of TPA, but this activity remained unchanged. Raised fibrinogen levels did not, therefore, appear to be mediated by the effect of protein C on fibrinolysis. Fibrinogen levels in plasma influence ADP induced platelet aggregation which is known to be increased in patients receiving coumarin drugs. In conclusion, patients on coumarin treatment, in addition to showing a reduction in protein C activity, also have higher fibrinogen levels and increased platelet aggregability all of which may be undesirable.
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Broekmans, A. W., F. J. M. der Meer, and K. Briët. "TREATMENT OF CONGENITAL THROMBOTIC SYNDROMES." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643718.
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Hereditary antithrombin III deficiency,protein C deficiency, and protein S deficiency predispose to the occurrence of venous thrombotic disease at a relatively youngage and often without an apparent cause. These disorders inherit as an autosomal dominant trait. Heterozygotes are at risk fosuperficial thrombophlebitis, thrombosis atnearly every venous site, and pulmonary embolism. Homozygous protein C deficiency may present itself with a purpura fulminans syndrome shortly after birth.In the acute phase of venous thromboembolism heparin is effective for preventing extension of the thrombotic process, and pulmonary embolism. In patients with antithrombin III deficiency the concomittant useof antithrombin III concentrate is controversial, although some patients may requirehigher doses of heparin.Substitution therapy is only indicated in homozygous protein C deficient patientswith purpura fulminans. Fresh frozen plasma i.v. is the treatment of choice, in a dosage of 10 ml/kg once or twice daily. The current prothrombin complex concentrates may induce new skin lesions and disseminated intravascular coagulation. After the lesions have been healed(mostly in 4 to6 weeks)coumarin therapy may effectively prevent new episodes of purpura fulminans, provided the prothrombin time is kept within 2,5 - 4,0 INR. Heparin is ineffective for preventing purpura fulminans due to homozygous protein C deficiency.The thrombotic manifestations in heterozygotes are effectively prevented by coumarin therapy. This is supported by the observation that patients may remain free of thrombosis during long-term treatment and may have recurrences shortly after the withdrawal of the coumarin drug. The therapeutic range for the prothrombin time should be within 2,0 - 4,0 INR, target value 3,0 INR. In the initial phase of oral anticoagulant therapy protein C deficient patients are prone to the development of coumarin induced hemorrhagic skin (tissue) necrosis.In the patients studied in Leiden, it occurred in about 3% of the treated patients. Heparin appears to be ineffective for the prevention of coumarin-induced skin necrosis; high loading doses of coumarin should be avoided and the prothrombin timeshouldbe checked dialy during the initial phase of oral anticoagulant treatment. Tissue necrosis may contribute to bleeding complications after fibrinolytic therapy, ashas been observed in two protein C deficient patients.In clinical situations with an increased risk for thrombosis such as surgery and pregnancy, heparin (in-low-doses) alone orin combination with coumarins have been used succesfully for the prevention of thrombosis. The need for antithrombin III concentrates in patients with hereditary antithrombin III deficiency in such situations is not substantiated.Although anabolic steroids are capable to increase the plasma concentrations of antithrombin III and of protein C in the respective deficiency states, its efficacy in preventing thrombotic episodes remains to be established.An optimal strategy for preventing thrombosis in congenital thrombotic syndromes is to identify still asymptomatic patients. In case of antithrombin III, protein C, and protein S deficiency this search is feasible. During risk situations for thrombosis patients are to be protected against the development of thrombosis.In Leiden pregnant women with one of the deficiencies are treated from the 14th week of pregnancy, initially with a shortacting coumarin drug, after the 34th week withheparin s.c. b.i.d. at therapeutic dosages,and after delivery coumarin therapy is reTnstituted during 6 weeks. The use of oralcontraceptives should be avoided, unlesspatients are under coumarin treatment. As long as deficient patients remain asymptomatic no antithrombotic treatment is indicated. After the first documented thromboticincident patients are treated indefinitelywith oral anticoagulants.
Reports on the topic "Oral anticoagulant therapy"
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Geng, Yu, Chang Meng, Tong Gao, Siyuan Li, Lei Bi, Yintang Wang, and Ping Zhang. The efficacy and safety of extended anticoagulation therapy with direct oral anticoagulant for patients with COVID-19: a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2023. http://dx.doi.org/10.37766/inplasy2023.1.0089.
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