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Published on: February 28, 2012

[Cardiac indications for oral anticoagulation]

M Roffi1, E Oechslin

  • 1Herz-Kreislauf-Zentrum, Kardiologie, Universitätsspital, Departement Innere Medizin, Zürich. marco.roffi@usz.ch

Praxis
|October 22, 2004
PubMed

Insights

Long-term oral anticoagulation requires balancing benefits against bleeding risks. New anticoagulants may offer fixed-dose, monitoring-free alternatives to warfarin for preventing thromboembolic events.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis Research

Context:

  • Oral anticoagulation is crucial for managing thromboembolic events.
  • Warfarin has been the long-standing standard treatment.
  • Emerging oral anticoagulants show promise for improved patient management.

Purpose:

  • To review the benefits and risks of long-term oral anticoagulation.
  • To discuss current indications and controversial uses of anticoagulation.
  • To highlight advancements in anticoagulant therapies.

Summary:

  • Balancing the reduction of thromboembolic events against bleeding risks is essential for individual patients on long-term oral anticoagulation.
  • Established indications include chronic atrial fibrillation, prosthetic heart valves, and left ventricular thrombus.
  • The efficacy of anticoagulation in stable sinus rhythm with impaired left ventricular function and secondary coronary artery disease prevention remains debated.
  • Novel oral thrombin inhibitors like ximelagatran demonstrate promising results.
  • Future anticoagulants may offer fixed-dose administration without the need for monitoring, potentially replacing warfarin.
  • Clinical trials are evaluating double antiplatelet therapy (aspirin and clopidogrel) for secondary prevention in atrial fibrillation.

Impact:

  • Informs clinical decision-making regarding oral anticoagulation therapy.
  • Highlights the potential shift towards more convenient and effective anticoagulant treatments.
  • Guides future research in anticoagulant and antiplatelet therapies for cardiovascular disease.

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