Established anticoagulants in secondary haemostasis

2009 ◽  
Vol 29 (03) ◽  
pp. 241-246
Author(s):  
S. Ziemer ◽  
E. Langer
Keyword(s):  
Vitamin K ◽  
Dose Response ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Short Review ◽  
Response Control ◽  
New Anticoagulants

SummaryIn respect to the actual discussion of new anticoagulants in secondary haemostasis, we will give a short review on established oral anti -coagulation with vitamin K antagonists and parenteral anticoagulation by use of heparin. The different cumarin derivatives phenprocoumon, warfarin, and acenocoumarol are compared concerning to the management and influence of pharmacogenetic and pharmacokinetic factors. Studies to improve the safety of oral anticoagulation by vitamin K supplementation will be briefly discussed. The therapy with heparins include until now some problems of dose-response control. It is necessary to pay attention to contra-indications even for well known anticoagulants. Examples for that will be given.

New Anticoagulants as an Alternative to Aspirin in Atrial Fibrillation – Implications of the Apixaban versus Acetylsalicylic Acid to Prevent Strokes (AVERROES) Trial

2011 ◽  
Vol 7 (3) ◽  
pp. 196
Author(s):  
Raffaele De Caterina ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Acetylsalicylic Acid ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Coagulation Factor ◽  
Clinical Information ◽  
Short Review ◽  
Factor X ◽  
New Anticoagulants ◽  
New Oral Anticoagulant

Atrial fibrillation (AF) is an extremely common arrhythmia, substantially increasing the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is, therefore, an important part of AF management. Guidelines until now have recommended that patients with AF receive some form of antithrombotic therapy, either as a vitamin K antagonist or aspirin, with a preference for anticoagulants in most cases. However, such current treatments are suboptimal, and despite recommendations, many patients do not receive adequate thromboprophylaxis because they are considered, for various reasons, ‘unsuitable’ to receive a vitamin K antagonists. In this patient population, apixaban, a new oral anticoagulant inhibiting activated coagulation factor X (FXa), administered in fixed doses and without anticoagulation monitoring, has undergone testing against aspirin in the recently published Apixaban versus acetylsalicylic acid to prevent strokes (AVERROES) trial. This short review will briefly address the strengths and limitations of this trial and the practical relevance of this new clinical information.

Spectrophotometric Assays of Prothrombin in Plasma of Patients Using Oral Anticoagulants

1979 ◽  
Vol 42 (04) ◽  
pp. 1296-1305 ◽  
Author(s):  
R M Bertina ◽  
W van der Marel-van Nieuwkoop ◽  
E A Loeliger
Keyword(s):  
Prothrombin Time ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Factor V ◽  
Anticoagulant Treatment ◽  
Factor Ii ◽  
K Deficiency

SummaryTwo spectrophotometric assays for prothrombin have been developed and compared with a one stage coagulant and an immunological assay. One of these assays (called the XAPC assay) uses a combination of factor Xa, phospholipid, Ca2+ and factor V as activator of prothrombin, and measures only normal prothrombin. The second (the ECAR assay) uses Echis carinatus venom as activator. This assay measures both normal prothrombin and PIVKA II (protein induced by vitamin K antagonists/absence). Combination of the results obtained by the XAPC and ECAR assays provides rapid and reliable information on the degree of “subcarboxylation” of prothrombin (oral anticoagulation, vitamin K deficiency).For patients on long term anticoagulant treatment the prothrombin time (Thrombotest) shows better correlation with the ratio prothrombin/prothrombin plus PIVKA II (XAPC/ ECAR) than with the factor II concentration. For patients starting the anticoagulant treatment there is no correlation between the Thrombotest time and the XAPC/ECAR ratio.It seems doubtful that (a) spectrophotometric factor II assay(s) will be as useful as the prothrombin time in the control of oral anticoagulation.

scholarly journals Inferior Vena Cava Agenesis and Deep Vein Thrombosis: A Pharmacological Alternative to Vitamin K Antagonists

2019 ◽  
Author(s):  
Inês Esteves Cruz ◽  
Pedro Ferreira ◽  
Raquel Silva ◽  
Francisco Silva ◽  
Isabel Madruga
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Inferior Vena ◽  
Vitamin K Antagonists ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Deep Vein

Inferior vena cava (IVC) agenesis is a rare congenital abnormality affecting the infrarenal segment, the suprarenal or the whole of the IVC. It has an estimated prevalence of up to 1% in the general population that can rise to 8.7% when abnormalities of the left renal vein are considered. Most IVC malformations are asymptomatic but may be associated with nonspecific symptoms or present as deep vein thrombosis (DVT). Up to 5% of young individuals under 30 years of age with unprovoked DVT are found to have this condition. Regarding the treatment of IVC agenesis-associated DVT, there are no standard guidelines. Treatment is directed towards preventing thrombosis or its recurrence. Low molecular weight heparin and oral anticoagulation medication, in particular vitamin K antagonists (VKAs) are the mainstay of therapy. Given the high risk of DVT recurrence in these patients, oral anticoagulation therapy is suggested to be pursued indefinitely. As far as we know, this is the first case reporting the use of a direct factor Xa inhibitor in IVC agenesis-associated DVT. Given VKA monitoring limitations, the use of a direct Xa inhibitor could be an alternative in young individuals with anatomical defects without thrombophilia, but further studies will be needed to confirm its efficacy and safety.

4037Nurse counseling of patients with atrial fibrillation to improve compliance to oral anticoagulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Chilian-Hof ◽  
S Schnupp ◽  
C Mahnkopf ◽  
J Brachmann ◽  
C Kleinecke
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Randomised Trial ◽  
Female Gender ◽  
Bleeding Risk ◽  
Telephone Counseling ◽  
Bleeding Events

Abstract Background Atrial fibrillation (AF) is the most frequent arrhythmia with a prevalence of 1%–2% in the general population. Oral anticoagulation (OAC) is state-of-the art for preventions of thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation. Despite its proven benefit, numerous studies have documented under use of OAC for a variety of reasons. Purpose To establish a program of nurse counseling in patient with atrial fibrillation and treatment with oral anticoagulation. The program is designed to improve patients satisfaction, compliance to OAC, prevention of medication errors, ischemic and bleeding events. Methods Patients with atrial fibrillation and treatment with oral anticoagulation were prospectively identified at the department of cardiology of our clinic. They received a 30 minutes nurse counseling about oral anticoagulation during the hospital stay and another 30 minutes telephone counseling 3 months after inclusion. Furthermore, they received a brochure to inform about atrial fibrillation, oral anticoagulation and methods to improve medication compliance. Demographic characteristics with stroke and bleeding risk (CHA2DS2-VASc and HAS-BLED scores), as well as procedural data were systematically assessed in a predefined standardized way and captured in a dedicated database. Results Between June 2017 and January 2018, a total of 617 patients (female gender: 43.1%) with atrial fibrillation and oral anticoagulation received nurse counseling. Demographic and follow-up data of 204 patients (female gender: 85/204 (41.7%); mean age 69.7±17.3, CHA2DS2-VASc score 4.2±1.7, HAS-BLED score 2.8±0.37) were assessed in a dedicated database. Indication for OAC was paroxysmal and persistent/permanent AF in 110/204 (53.9%), 93/204 (45.6%) and others 17 (8.3%), respectively. 33/2014 (16.2%) were treated with vitamin K antagonists, and 172/204 (84.3%) with non-vitamin K antagonists. After a follow-up of 0.46±2.9 years and 187 patients-years the rates of cardiovascular death, major bleeding events and all-cause stroke and TIA were 1.07%, 2.14% and 1.61% per 100 patient-years. Conclusion Nurse counseling in patients with atrial fibrillation and treatment with oral anticoagulation has been established at the REGIOMED clinics, Germany. Its effectiveness in terms of quality of live, medication complications and cardiovascular events has to be proven in a randomised trial. Acknowledgement/Funding Daichi-Sankyo

scholarly journals Vitamin K antagonists in children with heart disease: height and VKORC1 genotype are the main determinants of the warfarin dose requirement

Blood ◽  
2012 ◽  
Vol 119 (3) ◽  
pp. 861-867 ◽  
Author(s):  
Caroline Moreau ◽  
Fanny Bajolle ◽  
Virginie Siguret ◽  
Dominique Lasne ◽  
Jean-Louis Golmard ◽  
...  
Keyword(s):  
Vitamin K ◽  
Dose Response ◽  
Maintenance Dose ◽  
Vitamin K Antagonists ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Individual Variability ◽  
Dose Requirement ◽  
Warfarin Dose Requirement ◽  
Main Determinants

Abstract Managing vitamin K antagonist (VKA) therapy is challenging in children because of a narrow therapeutic range and wide inter- and intra-individual variability in dose response. Only a few small studies have investigated the effect of nongenetic and genetic factors on the dose response to VKAs in children. In a cohort study including 118 children (median age 9 years; range, 3 months-18 years) mostly with cardiac disease, we evaluated by multivariate analysis the relative contribution of nongenetic factors and VKORC1/CYP2C9/CYP4F2 genotypes on warfarin (n = 83) or fluindione (n = 35) maintenance dose and the influence of these factors on the time spent within/above/below the range. The results showed that height, target international normalized ratio and VKORC1 and CYP2C9 genotypes were the main determinants of warfarin dose requirement, accounting for 48.1%, 4.4%, 18.2%, and 2.0% of variability, respectively, and explaining 69.7% of the variability. Our model predicted the warfarin dose within 7 mg/wk in 86.7% of patients. None of the covariates was associated with the time spent above or below the international normalized ratio range. Whether this model predicts accurately the effective maintenance dose is currently being investigated.

Antikoagulation bei Vorhofflimmern

2012 ◽  
Vol 32 (01) ◽  
pp. 37-39 ◽  
Author(s):  
C. Bode ◽  
M. Moser
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
Additional Risk ◽  
New Anticoagulants ◽  
Therapeutic Anticoagulation ◽  
Impaired Quality

SummaryAtrial fibrillation is one of the most frequent reasons for therapeutic anticoagulation in everyday practice. Oral vitamin K antagonists such as Marcumar have been state of the art anticoagulants to prevent thrombembolic events in patients with atrial fibrillation and additional risk factors. But these drugs are accompanied by disadvantages such as increased bleeding risk and impaired quality of life caused by interactions with food or other medications as well as frequent controls of INRs.The new anticoagulants apixaban, rivaroxaban and dabigatran are direct antagonists of coagulation factors (FXa or FIIa) and demonstrate a promising risk/benefit profile in large clinical trials compared with vitamin K antagonists.Their approval for clinical use will open up new therapeutic perspectives for patients with atrial fibrillation and indication for anticoagulation.

Quality control of oral anticoagulation with vitamin K antagonists in primary care patients in Poland: a multi-centre study

2018 ◽  
pp. 764-769 ◽  
Author(s):  
Jolanta Sawicka-Powierza ◽  
Krzysztof Buczkowski ◽  
Sławomir Chlabicz ◽  
Zbigniew Gugnowski ◽  
Katarzyna Powierza ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Control ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Multi Centre Study ◽  
Centre Study ◽  
Primary Care Patients
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