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[Problems of long-term therapy with anticoagulants]
1Abteilung für Hämatologie/Hämostaseologie, Universitätsklinik für Innere Medizin I, Wien.
Insights
Oral anticoagulants effectively prevent blood clots in conditions like atrial fibrillation but carry bleeding risks. A lower anticoagulant level (INR 2.0-3.0) is now considered sufficient for preventing venous thromboembolism and cardiac emboli.
Area of Science:
- Cardiology
- Hematology
Context:
- Oral anticoagulants are crucial for preventing thromboembolic events in various cardiovascular conditions.
- Bleeding is a significant side effect, with fatal bleeding risk varying by treatment intensity.
Purpose:
- To review the efficacy and safety of oral anticoagulants.
- To highlight the standardization of prothrombin time measurement using the International Normalized Ratio (INR).
- To discuss recent findings on optimal anticoagulation intensity.
Summary:
- Oral anticoagulants are effective in preventing venous thromboembolism and thromboembolic complications in atrial fibrillation, dilated cardiomyopathy, and prosthetic heart valves.
- International Normalized Ratio (INR) has standardized prothrombin time determination.
- Current evidence suggests an INR range of 2.0 to 3.0 is adequate for preventing venous thromboembolism and cardiac emboli.
Impact:
- The findings support a refined approach to anticoagulation therapy, potentially reducing bleeding complications.
- Future monitoring may involve activation markers of coagulation for more precise management.
- Establishes a benchmark for optimal anticoagulation intensity in specific patient populations.
Abstract:
Oral anticoagulants are highly effective for the prevention of recurrence of venous thromboembolism and of thromboembolic complications in rheumatic and non-rheumatic atrial fibrillation, dilated cardiomyopathy and in patients with prosthetic heart valves, but less effective for prevention of arterial thrombosis. Bleeding is the main side effect, the risk of fatal bleeding is 0.2 to 0.4% per year, depending on the intensity of treatment. The problem of the standardization of the prothrombin time determination has been solved by the introduction of the international normalized ratio. Recent studies have shown that a lesser degree of anticoagulation (INR 2.0 to 3.0) is sufficient to prevent venous thromboembolism and cardiac emboli. The measurement of activation markers of coagulation will probably allow a more rational monitoring in the near future.