维生素K拮抗剂的药理学和管理:美国胸科医师学会循证临床实践指南(第八版)。

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Ansell J, Hirsh J,海里卡E,雅各布森,克洛泽M, Palareti G

维生素K拮抗剂的药理学和管理:美国胸科医师学会循证临床实践指南(第八版)。

胸部。2008年6月,133(6):160 - 198年代。doi: 10.1378 / chest.08 - 0670。

PubMed ID

18574265 (在PubMed

]

文摘

本文关于维生素K拮抗剂的药代学和药效学(VKAs)的一部分,美国胸科医师学会循证临床实践指南(第八版)。它描述了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,并提供特定的管理建议。1级建议强劲,表明,做或不做的好处大于风险,负担,和成本。二年级的建议表明,个别病人的价值观可能会导致不同的选择。(一个完整的理解的评分,请参阅“等级的建议”一章Guyatt et al,胸部2008;133:123s - 131)。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,5毫克之间的剂量和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(1 b级);我们建议对pharmacogenetic-based剂量直到随机数据表明它是有益的(2 c级);在老年人和其他病人子组使衰弱或营养不良,我们推荐起始剂量的<或= 5毫克(1级c)。本文还包括几个具体建议患者管理前置INR, INR治疗范围以上,和出血INR是否治疗或升高。 For the use of vitamin K to reverse a mildly elevated INR, we recommend oral rather than subcutaneous administration (Grade 1A). For patients with life-threatening bleeding or intracranial hemorrhage, we recommend the use of prothrombin complex concentrates or recombinant factor VIIa to immediately reverse the INR (Grade 1C). For most patients who have a lupus inhibitor, we recommend a therapeutic target INR of 2.5 (range, 2.0 to 3.0) [Grade 1A]. We recommend that physicians who manage oral anticoagulation therapy do so in a systematic and coordinated fashion, incorporating patient education, systematic INR testing, tracking, follow-up, and good patient communication of results and dose adjustments [Grade 1B]. In patients who are suitably selected and trained, patient self-testing or patient self-management of dosing are effective alternative treatment models that result in improved quality of anticoagulation management, with greater time in the therapeutic range and fewer adverse events. Patient self-monitoring or self-management, however, is a choice made by patients and physicians that depends on many factors. We suggest that such therapeutic management be implemented where suitable (Grade 2B).

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