Anticoagulant: Difference between revisions
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[[Warfarin]] is a commonly used oral anticoagulant that interferes with the Vitamin K dependent coagulation co-factors. | [[Warfarin]] is a commonly used oral anticoagulant that interferes with the Vitamin K dependent coagulation co-factors. | ||
== | ==Heparins== | ||
===Unfractionated heparin=== | |||
Details of the usage of heparin are available in [[clinical practice guideline]]s by the [[American College of Chest Physicians]]<ref name="pmid15383472">{{cite journal |author=Hirsh J, Raschke R |title=Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy |journal=Chest |volume=126 |issue=3 Suppl |pages=188S-203S |year=2004 |pmid=15383472 |doi=10.1378/chest.126.3_suppl.188S|url=http://www.chestjournal.org/cgi/content/full/126/3_suppl/204S}}</ref>: | Details of the usage of heparin are available in [[clinical practice guideline]]s by the [[American College of Chest Physicians]]<ref name="pmid15383472">{{cite journal |author=Hirsh J, Raschke R |title=Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy |journal=Chest |volume=126 |issue=3 Suppl |pages=188S-203S |year=2004 |pmid=15383472 |doi=10.1378/chest.126.3_suppl.188S|url=http://www.chestjournal.org/cgi/content/full/126/3_suppl/204S}}</ref>: | ||
* [http://www.chestjournal.org/cgi/content/full/126/3_suppl/188S/T4 Non-weight based heparin dose adjustment] | * [http://www.chestjournal.org/cgi/content/full/126/3_suppl/188S/T4 Non-weight based heparin dose adjustment] | ||
* [http://www.chestjournal.org/cgi/content/full/126/3_suppl/188S/T5 Weight-based heparin dose adjustment] | * [http://www.chestjournal.org/cgi/content/full/126/3_suppl/188S/T5 Weight-based heparin dose adjustment] | ||
===Low molecular weight heparin=== | |||
The last dose of low molecular weight heparin prior to procedures should occur 24 hours before the procedure in order to prevent high residual anti-Xa levels.<ref name="pmid17588394">{{cite journal |author=Whitlock RP, Crowther MA, Warkentin TE, Blackall MH, Farrokhyar F, Teoh KH |title=Warfarin cessation before cardiopulmonary bypass: lessons learned from a randomized controlled trial of oral vitamin K |journal=Ann. Thorac. Surg. |volume=84 |issue=1 |pages=103–8 |year=2007 |pmid=17588394 |doi=10.1016/j.athoracsur.2007.03.014}}</ref> | |||
==Direct thrombin inhibitors== | ==Direct thrombin inhibitors== | ||
Revision as of 05:07, 25 January 2008
Anticoagulants are "agents that prevent blood clotting".[1] They may be used to prevent embolism and thromboembolism.
Vitamin K antagonists
Warfarin
Warfarin is a commonly used oral anticoagulant that interferes with the Vitamin K dependent coagulation co-factors.
Heparins
Unfractionated heparin
Details of the usage of heparin are available in clinical practice guidelines by the American College of Chest Physicians[2]:
Low molecular weight heparin
The last dose of low molecular weight heparin prior to procedures should occur 24 hours before the procedure in order to prevent high residual anti-Xa levels.[3]
Direct thrombin inhibitors
Direct thrombin inhibitors bind directly to thrombin.[4]
- Argatroban is for treating heparin-induced thrombocytopenia (HIT)
- Bivalirudin is a recombinant protein
- Dabigatran
- Desirudin
- Hirudin is a recombinant protein for treating heparin-induced thrombocytopenia (HIT)
- Lepirudin
- Ximelagatran is a recombinant protein that is an oral direct thrombin inhibitor
Factor Xa inhibitors
Idraparinux is a synthetic derivative of heparin that has a long half life that allows once-weekly dosage. A randomized controlled trial compared idraparinux to warfarin and found that idraparinux is equivalent for deep venous thrombosis but is inferior for pulmonary embolism.[5]
Warfarin combined with heparin
Warfarin combined with heparin did not benefit survivors of acute myocardial infarction in a randomized controlled trial.[6]
Warfarin combined with heparin reduced events, but increased bleeding, among survivors of acute myocardial infarction in a randomized controlled trial.[7]
References
- ↑ Anonymous (2024), Anticoagulants (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Hirsh J, Raschke R (2004). "Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest 126 (3 Suppl): 188S-203S. DOI:10.1378/chest.126.3_suppl.188S. PMID 15383472. Research Blogging.
- ↑ Whitlock RP, Crowther MA, Warkentin TE, Blackall MH, Farrokhyar F, Teoh KH (2007). "Warfarin cessation before cardiopulmonary bypass: lessons learned from a randomized controlled trial of oral vitamin K". Ann. Thorac. Surg. 84 (1): 103–8. DOI:10.1016/j.athoracsur.2007.03.014. PMID 17588394. Research Blogging.
- ↑ Di Nisio M, Middeldorp S, Büller HR (2005). "Direct thrombin inhibitors". N. Engl. J. Med. 353 (10): 1028–40. DOI:10.1056/NEJMra044440. PMID 16148288. Research Blogging.
- ↑ Buller HR, Cohen AT, Davidson B, et al (2007). "Idraparinux versus standard therapy for venous thromboembolic disease". N. Engl. J. Med. 357 (11): 1094–104. DOI:10.1056/NEJMoa064247. PMID 17855670. Research Blogging.
- ↑ Fiore LD, Ezekowitz MD, Brophy MT, Lu D, Sacco J, Peduzzi P (2002). "Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study". Circulation 105 (5): 557–63. PMID 11827919. [e]
- ↑ Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H (2002). "Warfarin, aspirin, or both after myocardial infarction". N. Engl. J. Med. 347 (13): 969–74. DOI:10.1056/NEJMoa020496. PMID 12324552. Research Blogging.
See also
External links
The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines