维生素K拮抗剂的药理学和管理:第七ACCP会议抗凝和溶栓治疗。

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Bussey Ansell J, Hirsh J,轮询器L H,雅各布森,海里卡E

维生素K拮抗剂的药理学和管理:第七ACCP会议抗凝和溶栓治疗。

胸部。2004年9月,126(3):204 - 233年代。

PubMed ID

15383473 (在PubMed

]

文摘

本文关于维生素K拮抗剂的药代学和药效学(VKAs)是第七的一部分的美国胸科医师学会会议上抗栓和溶栓治疗:以证据为基础的指导方针。这篇文章描述了VKAs的抗血栓形成的作用,抗凝强度的监测,VKA治疗的临床应用,VKAs和最佳的治疗范围,并提供了具体的管理建议。1级的建议是强大的,和表明,福利,或不大于风险负担和成本。2级表明个别病人的价值观可能导致不同的选择(一个完整的理解的评分看到Guyatt et al,胸部2004;126:179s - 187)。本文中主要建议如下:VKAs的剂量,我们建议口服抗凝疗法的起始剂量之间的5和10毫克第一1或2天对大多数人来说,与后续计量的基础上,国际标准化比率(INR)响应(2 b级)。在老年人和其他病人子组出血风险偏高的,我们建议一个起始剂量在< = 5毫克(2 c级)。我们建议根据随后的剂量在最初的两个或三个剂量INR监测的结果(等级1 c)。本文还包括几个具体建议患者管理inr超过患者需要侵入性的治疗范围和程序。例如,在患者轻度至中度偏高inr没有出血,我们建议,当维生素K是鉴于它是口服药物而不是皮下注射(1 a级)。 For the management of patients with a low risk of thromboembolism, we suggest stopping warfarin therapy approximately 4 days before they undergo surgery (Grade 2C). For patients with a high risk of thromboembolism, we suggest stopping warfarin therapy approximately 4 days before surgery, to allow the INR to return to normal, and beginning therapy with full-dose unfractionated heparin or full-dose low-molecular-weight heparin as the INR falls (Grade 2C). In patients undergoing dental procedures, we suggest the use of tranexamic acid mouthwash (Grade 2B) or epsilon amino caproic acid mouthwash without interrupting anticoagulant therapy (Grade 2B) if there is a concern for local bleeding. For most patients who have a lupus inhibitor, we suggest a therapeutic target INR of 2.5 (range, 2.0 to 3.0) [Grade 2B]. In patients with recurrent thromboembolic events with a therapeutic INR or other additional risk factors, we suggest a target INR of 3.0 (range, 2.5 to 3.5) [Grade 2C]. As models of anticoagulation monitoring and management, we recommend that clinicians incorporate patient education, systematic INR testing, tracking, and follow-up, and good communication with patients concerning results and dosing decisions (Grade 1C+).

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药物

华法令阻凝剂