Difference between revisions of "Anticoagulant"

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(External links: Updated link to the Chest supplement)
(Factor Xa inhibitors)
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==Factor Xa inhibitors==
 
==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]].<ref name="pmid17855670">{{cite journal |author=Buller HR, Cohen AT, Davidson B, ''et al'' |title=Idraparinux versus standard therapy for venous thromboembolic disease |journal=N. Engl. J. Med. |volume=357 |issue=11 |pages=1094–104 |year=2007 |pmid=17855670 |doi=10.1056/NEJMoa064247}}</ref>
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* [[Fondaparinux]]
 
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* [[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]].<ref name="pmid17855670">{{cite journal |author=Buller HR, Cohen AT, Davidson B, ''et al'' |title=Idraparinux versus standard therapy for venous thromboembolic disease |journal=N. Engl. J. Med. |volume=357 |issue=11 |pages=1094–104 |year=2007 |pmid=17855670 |doi=10.1056/NEJMoa064247}}</ref>
[[Rivaroxaban]] can prevent [[embolism and thrombosis]] during [[perioperative care]] according to [[randomized controlled trials]].<ref>Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008  {{doi|10.1016/S0140-6736(08)60880-6}}</ref><ref>[[http://content.nejm.org/cgi/content/short/358/26/2776 Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Total Knee Arthroplasty]]. New England Journal of Medicine 2008</ref><ref>[http://content.nejm.org/cgi/content/short/358/26/2765 Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty]. New England Journal of Medicine 2008</ref>
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* [[Rivaroxaban]] can prevent [[embolism and thrombosis]] during [[perioperative care]] according to [[randomized controlled trials]].<ref>Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008  {{doi|10.1016/S0140-6736(08)60880-6}}</ref><ref>[[http://content.nejm.org/cgi/content/short/358/26/2776 Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Total Knee Arthroplasty]]. New England Journal of Medicine 2008</ref><ref>[http://content.nejm.org/cgi/content/short/358/26/2765 Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty]. New England Journal of Medicine 2008</ref>
  
 
==Warfarin combined with heparin==
 
==Warfarin combined with heparin==

Revision as of 19:13, 6 November 2008

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Anticoagulants are "agents that prevent blood clotting".[1] They may be used to prevent embolism and thrombosis.

[edit intro]

Vitamin K antagonists

Warfarin

For more information, see: 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]

Factor Xa inhibitors

Warfarin combined with heparin

Warfarin combined with heparin did not benefit survivors of acute myocardial infarction in a randomized controlled trial.[9]

Warfarin combined with heparin reduced events, but increased bleeding, among survivors of acute myocardial infarction in a randomized controlled trial.[10]

References

  1. Anonymous (2020), Anticoagulants (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008 DOI:10.1016/S0140-6736(08)60880-6
  7. [Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Total Knee Arthroplasty]. New England Journal of Medicine 2008
  8. Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty. New England Journal of Medicine 2008
  9. 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]
  10. 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