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Anticoagulant Therapy with Warfarin for Thrombotic Disorders

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Antithrombotics

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 132))

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Abstract

Important advances have been made during the past 20 years in the clinical use of oral anticoagulants. It is now established that oral anticoagulation provides effective antithrombotic therapy for the prevention and management of venous thromboembolism, the prevention of systemic embolism in patients with atrial fibrillation, mechanical prosthetic heart valves or acute myocardial infarction, and the secondary prevention of myocardial infarction. Evidencebased recommendations provide optimal efficacy and safety by maintaining a narrow range of anticoagulation using laboratory-monitored dosing (HIRSH et al. 1994a; DALEN and HIRSH 1995).

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References

  • Altman R, Rouvier J, Gurfinkel E, D’Ortencio O, Manzanel R, de La Fuente L et al (1991) Comparison of two levels of anticoagulant therapy in patients with substitute heart valves. J Thorac Cardiovasc Surg 101:427–431

    PubMed  CAS  Google Scholar 

  • Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis Research Group (ASPECT) (1994) Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Lancet 343:499–503

    Google Scholar 

  • British Society for Haematology (1990) Guidelines on oral anticoagulation, 2nd edn. British Committee for Standards in Haematology. Haemostasis and Thrombosis Task Force. J Clin Pathol 43:177–183

    Article  Google Scholar 

  • Broekmans AW, Bertina RM, Loeliger EA, Hofmann V, Kingeman HG (1983) Protein C and the development of skin necrosis during anticoagulant therapy. Thromb Haemost 49:251

    PubMed  CAS  Google Scholar 

  • Cairns JA, Hirsh J, Lewis HD Jr, Resnekov L, Theroux P (1992) Antithrombotic agents in coronary artery disease. Chest 102:456S–481S

    Article  PubMed  CAS  Google Scholar 

  • Chesebro JH, Fuster V, Elveback LR, McGoonn DC, Pluth JR, Puga FJ et al (1983) Trial of combined warfarin plus dipyridamole on aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol 51:1537–1541

    Article  PubMed  CAS  Google Scholar 

  • Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns J A, Joyner, C (1991) Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Am Coll Cardiol 18:349–355

    Article  PubMed  CAS  Google Scholar 

  • Cortelazzo S, Finazzi G, Viero P, Galli M, Remuzzi A, Parenzan L et al (1993) Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Thromb Haemost 69:316–320

    PubMed  CAS  Google Scholar 

  • Dahlback B (1995) Inherited thrombophilia: resistance to activated protein C as a pathogenic factor of venous thromboembolism. Blood 85:607–614

    PubMed  CAS  Google Scholar 

  • Dale C, Gallus AS, Wycherley A, Langlois S, Howie D (1991) Prevention of venous thrombosis with minidose warfarin after joint replacement. BMJ 303:224

    Article  PubMed  CAS  Google Scholar 

  • Dale J, Myhre E, Loew D (1980) Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement. Am Heart J 99:746–752

    Article  PubMed  CAS  Google Scholar 

  • Dalen JE, Hirsh J (1995) Fouth ACCP Consensus Conference on Antithrombotic Therapy. Chest 108:225S–522S

    Article  Google Scholar 

  • den Heijer M, Blom HJ, Gerrits WBJ, Rosendaal FR, Haak HL, Wijermans PW et al (1995)Is hyperhomocysteinaemia a risk factor for recurrent venous thrombosis? Lancet 345:882–885

    Google Scholar 

  • Drapkin A, Merskey C (1972) Anticoagulant therapy after acute myocardial infarction. Relation of therapeutic benefit to a patient’s age, sex, and severity of infarction. JAMA 222:541–548

    CAS  Google Scholar 

  • European Atrial Fibrillation Trial Study Group (1993) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342:1255–1262

    Google Scholar 

  • Ezekowitz MD, Bridgers SL, James KE (1991) Interim analysis of VA Co-operative Study, Stroke Prevention in Non-rheumatic Atrial Fibrillation (SPINAF). Circulation 84:11–450

    Google Scholar 

  • Fordyce MJF, Baker AS, Staddon GE (1991) Efficacy of fixed minidose warfarin prophylaxis in total hip replacement. BMJ 303:219–220

    Article  PubMed  CAS  Google Scholar 

  • Francis CW, Marder VJ, Evarts CM, Yaukoolbodi S (1983) Two-step warfarin therapy. Prevention of postoperative venous thrombosis without excessive bleeding. JAMA 249:374–378

    CAS  Google Scholar 

  • Furie B, Diuguid CF, Jacobs M, Diguid DL, Furie BC (1990) Randomized prospective trial comparing the native prothrombin antigen with the prothrombin time for monitoring anticoagulant therapy. Blood 75:344–349

    PubMed  CAS  Google Scholar 

  • Fuster V, Pumphrey CW, McGoon MD, Chesebro JH, Pluth JR, McGoon DC (1982) Systemic thromboembolism in mitral and aortic Starr-Edwards prosthesis: a 10-19 year follow-up. Circulation 66:1–157-1-161

    Article  Google Scholar 

  • Ginsberg JS (1996) Management of venous thromboembolism. N Engl J Med 335:1816–1828

    Article  PubMed  CAS  Google Scholar 

  • Ginsberg JS, Hirsh J (1995) Use of antithrombotic agents during pregnancy. Chest 108:305S–311S

    Article  PubMed  CAS  Google Scholar 

  • Ginsberg JS, Wells PS, Brill-Edwards P, Donovan D, Moffatt K, Johnston M et al (1995) Antiphospholipid antibodies and venous thromboembolism. Blood 86:3685–3691

    PubMed  CAS  Google Scholar 

  • Grimaudo V, Gueissaz F, Hauert J, Sarraj A, Kruithaf EKO, Bachmann F (1989) Necrosis of skin induced by coumarin in a patient deficient in protein S. BMJ 298:233–234

    Article  PubMed  CAS  Google Scholar 

  • Hall JG, Pauli RM, Wilson KM (1980) Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 68:122–140

    Article  PubMed  CAS  Google Scholar 

  • Heijboer H, Brandjes DP, Buller, HR, Sturk A, ten-Cate JW (1990) Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. N Engl J Med 323:1512–1516

    Article  PubMed  CAS  Google Scholar 

  • Hirsh J, Ginsberg JS, Marder VJ (1994a) Anticoagulant therapy with coumarin agents. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and thrombosis: basic principles and clinical practice, 3rd edn. Lippincott, Philadelphia, pp 1567–1583

    Google Scholar 

  • Hirsh J, Prins MH, Samama M (1994b) Therapeutic agents and their practical use in thrombotic disorders. Approach to the thrombophilic patient for hemostasis and thrombosis: basic principles and clinical practice. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and thrombosis: basic principles and clinical practice, 3rd edn. Lippincott, Philadelphia, pp 1543–1561

    Google Scholar 

  • Hirsh J, Dalen JE, Deykin D, Poller L, Bussey H (1995) Oral anticoagulants. Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 108:231S–246S

    CAS  Google Scholar 

  • Hull R, Delmore T, Genton E, Hirsh J, Gent M, Sackett D et al (1979) Warfarin sodium versus low dose heparin in the long-term treatment of venous thrombosis. N Engl J Med 301:855–858

    Article  PubMed  CAS  Google Scholar 

  • Hull R, Delmore T, Carter C, Hirsh J, Genton E, Gent M et al (1982a) Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med 306:189–194

    Article  PubMed  CAS  Google Scholar 

  • Hull R, Hirsh J, Jay R, Carter C, England C, Gent M et al (1982b) Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 307:1676–1681

    Article  PubMed  CAS  Google Scholar 

  • Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T et al (1993) A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med 329:1370–1376

    Article  PubMed  CAS  Google Scholar 

  • Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120:897–902

    PubMed  CAS  Google Scholar 

  • Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U (1985) Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 2:515–518

    Article  PubMed  CAS  Google Scholar 

  • Landefeld CS, Goldman L (1989) Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144–152

    Article  PubMed  CAS  Google Scholar 

  • Landefeld CS, Rosenblatt MW, Goldman L (1989) Bleeding in outpatients treated with warfarin: relation to the prothrombin time and important remediable lesions. Am J Med 87:153–159

    Article  PubMed  CAS  Google Scholar 

  • Levine MN, Raskob G, Landefeld, S, Hirsh J (1995) Hemorrhagic complications of long-term anticoagulant therapy. Chest 108:291–301

    Article  Google Scholar 

  • Loeliger EA, Poller L, Samama M, Thomson JM, Van den Besselaar AM, Vermylen J et al (1985) Questions and answers on prothrombin time standardisation in oral anticoagulant control. Thromb Haemost 54:515–517

    PubMed  CAS  Google Scholar 

  • Malhotra OP, Nesheim ME, Mann KG (1985) The kinetics of activation of normal and gamma-carboxyglutamic acid-deficient prothrombins. J Biol Chem 260:279–287

    PubMed  CAS  Google Scholar 

  • McKenna R, Cole ER, Vasan U (1983)Is warfarin sodium contraindicated in the lactating mother? J Pediatr 103:325–327

    CAS  Google Scholar 

  • Medical Research Council Group (1969) Assessment of short-term anticoagulant administration after cardiac infarction. Report of the Working Party on Anticoagulant Therapy in Coronary Thrombosis. BMJ 1:335–342

    Google Scholar 

  • Mok CK, Boey J, Wang R, Chan TK, Cheung KL, Lee PK et al (1985) Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial. Circulation 72:1059–1063

    Article  PubMed  CAS  Google Scholar 

  • Petersen P, Godtfredsen J, Andersen B, Boysen G, Andersen ED (1989) Placebocontrolled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet i:175-179

    Google Scholar 

  • Poller L (1988) A simple nomogram for the derivation of international normalised ratios for the standardisation of prothrombin times. Thromb Haemost 60:18–20

    PubMed  CAS  Google Scholar 

  • Poller L, Hirsh J (1992) Optimal therapeutic ranges for oral anticoagulation. In: Fuster V, Verstraete M (eds) Thrombosis in cardiovascular disorders. Saunders, Philadelphia

    Google Scholar 

  • Poller L, Wright D, Rowlands M (1993) Prospective comparative study of computer programs used for management of warfarin. J Clin Pathol 46:299–303

    Article  PubMed  CAS  Google Scholar 

  • Powers PJ, Gent M, Jay RM, Julian DH, Turpie AGG, Levine M (1989) A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch Intern Med 149:771–774

    Article  PubMed  CAS  Google Scholar 

  • Research Committee of the British Thoracic Society (1992) Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Lancet 340:873–876

    Google Scholar 

  • Sadowski JA et al (1991) Warfarin and the metabolism function of vitamin K. In: Poller L (ed) Recent advances in blood coagulation, no 5.Churchill Livingstone, Edinburgh, pp 93–118

    Google Scholar 

  • Samama M, Horellou MH, Soria J, Conard J, Nicolas G (1984) Successful progressive anticoagulation in a severe protein C deficiency and previous skin necrosis at the initiation of oral anticoagulation treatment. Thromb Haemost 51:132–133

    PubMed  CAS  Google Scholar 

  • Saour JN, Sieck JO, Mamo LA, Gallus AS (1990) Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med 322:428–432

    Article  PubMed  CAS  Google Scholar 

  • Sherman DG, Dyken ML Jr, Gent M, Harrison JG, Hart RG, Hohr JP (1995) Antithrombotic therapy for cerebrovascular disorders. An Update. Chest 108: 444–456

    Google Scholar 

  • Sixty-Plus Reinfarction Study Group (1980) A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Lancet ii:989-994

    Google Scholar 

  • Smith P, Arnesen H, Holme I (1990) The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med 323:147–151

    Article  PubMed  CAS  Google Scholar 

  • Stroke Prevention in Atrial Fibrillation Investigators (1994) Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 343:687–691

    Google Scholar 

  • The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators (1990) The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 323:1505–1511

    Article  Google Scholar 

  • The Stroke Prevention in Atrial Fibrillation Investigators (1991) The stroke prevention in atrial fibrillation trial: final results. Circulation 84:527–539

    Google Scholar 

  • Turpie AGG, Gunstensen J, Hirsh J, Nelson H, Gent M (1988) Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet i: 1242-1245

    Google Scholar 

  • Turpie AGG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F (1993) A comparison of aspirin with placebo in patients treated with warfarin after heartvalve replacement. N Engl J Med 329:524–529

    Article  PubMed  CAS  Google Scholar 

  • Verhagen H (1954) Local haemorrhage and necrosis of the skin and underlying tissues during anti-coagulant therapy with dicumarol or dicumacyl. Acta Med Scand 148:455–467

    Google Scholar 

  • Veterans Administration Cooperative Study (1973) Anticoagulants in acute myocardial infarction. Results of a cooperative clinical trial. JAMA 225:724–729

    Google Scholar 

  • Weinberg AC, Lieskovsky G, McGehee WG, Skinner DG (1983) Warfarin necrosis of the skin and subcutaneous tissue of the male external genitalia. J Urol 130:352–354

    PubMed  CAS  Google Scholar 

  • Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J (1990) Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin Ill-independent inhibitors. J Clin Invest 86:385–391

    Article  PubMed  CAS  Google Scholar 

  • Zauber NP, Stark MW (1986) Successful warfarin anticoagulation despite protein C deficiency and a history of warfarin necrosis. Ann Intern Med 104:659–660

    PubMed  CAS  Google Scholar 

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© 1999 Springer-Verlag Berlin Heidelberg

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Harker, L.A. (1999). Anticoagulant Therapy with Warfarin for Thrombotic Disorders. In: Uprichard, A.C.G., Gallagher, K.P. (eds) Antithrombotics. Handbook of Experimental Pharmacology, vol 132. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59942-2_12

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  • DOI: https://doi.org/10.1007/978-3-642-59942-2_12

  • Publisher Name: Springer, Berlin, Heidelberg

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