The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

Chest
Jack AnsellElaine Hylek

Abstract

This article concerning the pharmacokinetics and pharmacodynamics of vitamin K antagonists (VKAs) is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. The article describes the antithrombotic effect of VKAs, the monitoring of anticoagulation intensity, the clinical applications of VKA therapy, and the optimal therapeutic range of VKAs, and provides specific management recommendations. Grade 1 recommendations are strong, and indicate that the benefits do, or do not, outweigh the risks, burdens, and costs. Grade 2 suggests that individual patient's values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this article are the following: for dosing of VKAs, we suggest the initiation of oral anticoagulation therapy with doses between 5 and 10 mg for the first 1 or 2 days for most individuals, with subsequent dosing based on the international normalized ratio (INR) response (Grade 2B). In the elderly and in other patient subgroups with an elevated bleeding risk, we suggest a starting dose at < or = 5 mg (Grade 2C). We recommend basing subsequent do...Continue Reading

References

Jan 1, 1979·Clinical Pharmacokinetics·J G Kelly, K O'Malley
Aug 1, 1979·Clinical Pharmacology and Therapeutics·B M Rothschild
Jan 1, 1976·Annual Review of Medicine·R A O'Reilly
Sep 27, 1977·Biochimica Et Biophysica Acta·P A FriedmanA Fitz-James
Aug 12, 1976·The New England Journal of Medicine·R A O'Reilly
Sep 1, 1975·The Journal of Clinical Investigation·G J Roth, P W Majerus
Aug 1, 1992·Journal of Clinical Pathology·A H JamesS G Thompson
Nov 15, 1992·Annals of Internal Medicine·D Mungall, R White
Mar 1, 1992·Archives of Internal Medicine·S A McCurdy, R H White
Apr 1, 1992·Medical Decision Making : an International Journal of the Society for Medical Decision Making·D L KentS D Fihn
Jun 1, 1992·Annals of Internal Medicine·J H GurwitzJ Ansell
Aug 15, 1992·Annals of Internal Medicine·M H Rosove, P M Brewer
Dec 2, 1991·The Medical Journal of Australia·J C Martin
Aug 1, 1991·Journal of the American College of Cardiology·S J ConnollyC Joyner
Jul 27, 1991·BMJ : British Medical Journal·M J FordyceG E Staddon
Jul 27, 1991·BMJ : British Medical Journal·C DaleD Howie
May 1, 1991·Age and Ageing·M RedwoodJ H Matthews
Jul 19, 1990·The New England Journal of Medicine·P SmithI Holme
Nov 29, 1990·The New England Journal of Medicine·UNKNOWN Boston Area Anticoagulation Trial for Atrial Fibrillation InvestigatorsJ Philip Kistler
Nov 1, 1990·American Journal of Surgery·G R SeabrookJ B Towne
Feb 15, 1990·The New England Journal of Medicine·J N SaourA S Gallus
Aug 1, 1990·Journal of Clinical Pathology·J M ThomsonL Poller
Nov 11, 1989·BMJ : British Medical Journal·P J RyanP E Rose
Jan 28, 1989·BMJ : British Medical Journal·V GrimaudoF Bachmann
Mar 30, 1989·The New England Journal of Medicine·S Sindet-PedersenM Blombäck
Jun 1, 1989·British Journal of Rheumatology·T Pullar
Feb 1, 1989·British Journal of Rheumatology·S Schulman, K Henriksson
Jan 1, 1989·Journal of Clinical Pathology·L PollerD A Taberner
Jan 1, 1988·Annual Review of Nutrition·P A Price
May 9, 1987·British Medical Journal·L Poller
Feb 1, 1988·International Journal of Cardiology·R CharneyV Fuster

❮ Previous
Next ❯

Citations

Jul 16, 2008·Archives of Neurology·Hen HalleviJames C Grotta
Jun 13, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Philippe de MoerlooseSerge Motte
Jun 13, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Brigitte E Ickx, Annick Steib
Jan 26, 2007·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·S M SchellongS Haas
Jan 30, 2007·Intensive Care Medicine·Bernard ViguéDan Benhamou
Jan 18, 2006·European Journal of Clinical Pharmacology·Job HarenbergChristel Weiss
Mar 23, 2006·European Journal of Clinical Pharmacology·Darja HermanVita Dolzan
Sep 13, 2011·Neurosurgical Review·Andrew F DucruetE Sander Connolly
Apr 22, 2008·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Mohammed Haris Umer UsmanMichael Ezekowitz
Jan 17, 2009·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Margaret C Fang
Apr 9, 2005·Journal of Thrombosis and Thrombolysis·David A GarciaMark A Crowther
Nov 2, 2005·Journal of Thrombosis and Thrombolysis·Kandace V AnichRachana J Patel
Apr 20, 2006·Journal of Thrombosis and Thrombolysis·Chaitanya SarawateOle Hauch
Feb 14, 2006·Journal of Thrombosis and Thrombolysis·Andrew Dunn
Feb 14, 2006·Journal of Thrombosis and Thrombolysis·Alex C Spyropoulos
Dec 23, 2006·Journal of Thrombosis and Thrombolysis·Sarah E WilsonMark A Crowther
Oct 2, 2007·Journal of Thrombosis and Thrombolysis·Scott Kaatz
Oct 18, 2007·Journal of Thrombosis and Thrombolysis·Amir K Jaffer
Oct 2, 2007·Journal of Thrombosis and Thrombolysis·Wendy A Leong
Mar 14, 2008·Journal of Thrombosis and Thrombolysis·Robin R HillDaniel M Witt
Apr 9, 2008·Journal of Thrombosis and Thrombolysis·Geno J Merli, George Tzanis
May 10, 2008·Journal of Thrombosis and Thrombolysis·Emily B DevineAnn K Wittkowsky
Feb 20, 2009·Journal of Thrombosis and Thrombolysis·Joan-Carles Trullas-VilaRosa Gispert-Magarolas
Nov 23, 2013·Journal of Thrombosis and Thrombolysis·Camilo Molino GuidoniLeonardo Regis Leira Pereira
Jun 7, 2007·Internal and Emergency Medicine·M MariettaG Torelli
Jan 4, 2008·Internal and Emergency Medicine·G Palareti
Aug 29, 2012·Internal and Emergency Medicine·Marco MoiaPier Mannuccio Mannucci
Dec 15, 2007·Vascular Health and Risk Management·Ramandeep Sahni, Jesse Weinberger
Nov 19, 2010·Current Neurology and Neuroscience Reports·Simerpreet BalMichael D Hill
Dec 24, 2013·Current Treatment Options in Neurology·Carter Gerard, Katharina M Busl
Jan 25, 2008·Neurocritical Care·Joshua N GoldsteinLee H Schwamm
Sep 12, 2012·Neurocritical Care·Charles M AndrewsScott D Weingart
Oct 23, 2008·Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico·Miriam López-GómezManuel González Barón
Jun 12, 2013·European Journal of Drug Metabolism and Pharmacokinetics·Takeshi KadokuraHartmut Onkels
Jan 25, 2013·Clinical Pharmacokinetics·Anne-Charlotte CastellanUNKNOWN Genophar Working Group
May 19, 2005·Disease-a-month : DM·Alex C Spyropoulos
Aug 27, 2011·Journal of Medicinal Chemistry·Kamil KamińskiRadosław Lach
Nov 3, 2005·Nature Clinical Practice. Cardiovascular Medicine·Jack E Ansell
Feb 1, 2006·Nature Clinical Practice. Cardiovascular Medicine·Christina M WyattJonathan A Winston
Feb 28, 2008·European Journal of Human Genetics : EJHG·Darlene J Elias, Eric J Topol

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.