Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Apr 2011
ReviewDrug and dietary interactions of warfarin and novel oral anticoagulants: an update.
Clinicians and patients around the world have been intrigued by the concept of developing an oral anticoagulant with a broad therapeutic window and few drug and dietary interactions that can be administered at fixed doses with no or minimal monitoring. The recently approved oral direct thrombin inhibitor dabigatran, along with the emerging oral anti-factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have been developed to address many of the shortcomings of warfarin therapy. As warfarin is associated with extensive food and drug interactions, there is also a need to consider such interactions with the new oral anticoagulants. ⋯ Pharmacokinetic and pharmacodynamic profiles will have to be closely accounted for when determining the likelihood of a potential drug interaction prior to therapy initiation. As the list of drugs and supplements that interact with warfarin is continuously expanding, and the knowledge on drug interactions with the novel oral anticoagulants is still in its infancy, clinicians need to be vigilant when initiating any of these agents or when any changes in the patient's medication profile occur and perform a close screening for potential drug and dietary interactions. The objective of this paper is to give an update on drug and dietary interactions with warfarin and the novel oral anticoagulants, dabigatran, rivaroxaban, apixaban, and edoxaban.
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J. Thromb. Thrombolysis · Jan 2011
ReviewProphylaxis for venous thromboembolism: guidelines translated for the clinician.
Venous thromboembolism is a major cause of morbidity and mortality worldwide and most often affects hospitalized postoperative surgical and medical patients. Venous thromboembolism prophylaxis undoubtedly improves the care of these patients, as demonstrated by the current literature and guidelines. Failure to prescribe prophylaxis when indicated, however, remains a vital health care concern. ⋯ We will briefly review the grading system used in the guidelines for the level of evidence and the strength of the recommendation. We will then discuss the recommendations for prophylaxis in the various patient populations described in these guidelines including general and orthopedic surgery, gynecologic surgery, urologic surgery, thoracic surgery, neurosurgery, trauma, medical conditions, cancer patients, and critical care. In addition, we will discuss recent clinical trials regarding novel anticoagulants for venous thromboembolism prophylaxis and share some conclusions.
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Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but usually preventable complication of hospitalization associated with substantial mortality, morbidity, and health care costs. Despite published guidelines for the prevention of VTE among hospitalized patients, underutilization of prophylaxis continues to be a problem in the United States, Canada, and worldwide. ⋯ While extended out-of-hospital prophylaxis has been validated in the orthopedic and surgical oncology literature, data regarding the prevention of VTE in other hospitalized patient populations after discharge have been limited. In this review article, we discuss decision support strategies for improving VTE prevention during hospitalization and at the time of discharge.
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J. Thromb. Thrombolysis · Feb 2010
ReviewWarfarin anticoagulation reversal: management of the asymptomatic and bleeding patient.
The management of patients with supra-therapeutic INR in a common clinical problem. The risk of bleeding is influenced by the intensity, variability and duration of anticoagulation, patient age, presence of co-morbidities and concomitant drug therapy. For the asymptomatic patient, warfarin discontinuation is all that is usually required but for individuals at high risk of bleeding and those with INR > 10, oral vitamin K administration is recommended. In the presence of major bleeding, treatment with intravenous vitamin K and prothrombin complex concentrate is the most effective therapy.
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J. Thromb. Thrombolysis · Feb 2010
Review Case ReportsImpact on patient care: patient case through the continuum of care.
Hospitalized patients are at increased risk of venous thromboembolism and the Joint Commission has initiated practice measures to improve the rates of preventable events. The Joint Commission also initiated the National Patient Safety Goals for medication prescribing and administration, of which, goal 03.05.01 is specifically aimed at anticoagulation therapy. These measures and goals are consistent with the American College of Chest Physicians' Consensus Guidelines on Antithrombotic and Thrombolytic Therapy. This narrative review uses a case-based approach that brings up practical clinical questions regarding these measures, goals and guidelines as they apply to a patient going through the continuum of care from the hospital to their home.