Seminars in thrombosis and hemostasis
-
Although vitamin K antagonists (VKAs) such as warfarin have been used clinically for decades, evidence supporting how best to manage their use in clinical practice is lacking, but continues to emerge. This article summarizes available information regarding the clinical management of VKAs with focus on dosing strategies. For patients with previously stable international normalized ratio (INR) control, the single mildly out-of-range INR does not warrant a change in VKA dose. ⋯ Patient self-management of VKA therapy offers advantages for motivated patients who can demonstrate competency in self-management including fingerstick INR testing. Most patients with excessive anticoagulation who are not bleeding can be managed without administering vitamin K. There is an ongoing need for research evaluating VKA dosing practices that can consistently improve the outcomes of VKA therapy.
-
Semin. Thromb. Hemost. · Oct 2012
ReviewApproach to the diagnosis and management of common bleeding disorders.
Mild mucocutaneous bleeding symptoms are common in the general population. Differentiating normal from pathological bleeding complaints begins with a detailed bleeding history that assesses: the pattern (primary versus secondary hemostasis), the severity, and the onset (congenital versus acquired) of bleeding. ⋯ Clinical management focuses on the particular symptoms experienced by the patient. Medical interventions include replacement of the factor that is deficient or defective, or indirect treatments, such as antifibrinolytics (tranexamic acid), desmopression, and hormone-based therapy (e.g., oral contraceptive pill for menorrhagia).