Abstract
Each year half a million persons in the United States receive long-term anticoagulant therapy to prevent venous and arterial thromboembolism. Unfortunately, the relative benefits and risks of anticoagulant therapy have not been adequately quantified for many thromboembolic disorders, and the decisions as to whether, for how long, and how intensely to administer anticoagulation are often complex and controversial. Several expert panels have published recommendations for anticoagulant therapy for different thromboembolic disorders; the primary area of disagreement among these panels concerns the optimal intensity of anticoagulation. Recent research and analytic reviews have helped to clarify both the risk factors for and the appropriate diagnostic evaluation of anticoagulant-induced hemorrhage. Clinicians must be aware of the nonhemorrhagic complications of anticoagulant therapy, particularly during pregnancy. The administration of anticoagulants is difficult both in relation to dosing and long-term monitoring. Knowledge of the pharmacology of the anticoagulants, an organized approach to ongoing monitoring, and thorough patient education may facilitate the safe and effective use of these drugs.
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Selected References
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- Adams P. C., Cohen M., Chesebro J. H., Fuster V. Thrombosis and embolism from cardiac chambers and infected valves. J Am Coll Cardiol. 1986 Dec;8(6 Suppl B):76B–87B. doi: 10.1016/s0735-1097(86)80009-2. [DOI] [PubMed] [Google Scholar]
- Adler E., Benjamin S. B., Zimmerman H. J. Cholestatic hepatic injury related to warfarin exposure. Arch Intern Med. 1986 Sep;146(9):1837–1839. [PubMed] [Google Scholar]
- Antolak S. J., Jr, Mellinger G. T. Urologic evaluation of hematuria occurring during anticoagulant therapy. J Urol. 1969 Jan;101(1):111–113. doi: 10.1016/s0022-5347(17)62288-2. [DOI] [PubMed] [Google Scholar]
- Barkin M., Lopatin W., Herschorn S., Comisarow R. Unexplained hematuria. Can J Surg. 1983 Nov;26(6):501–503. [PubMed] [Google Scholar]
- Bartter T., Hollingsworth H. M., Irwin R. S., Bianco J. A., Frid D. J., Dalen J. E. Pulmonary embolism from a venous thrombus located below the knee. Arch Intern Med. 1987 Feb;147(2):373–375. [PubMed] [Google Scholar]
- Bell W. R. Heparin-associated thrombocytopenia and thrombosis. J Lab Clin Med. 1988 Jun;111(6):600–605. [PubMed] [Google Scholar]
- Bjerkelund C. J., Orning O. M. The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation. Am J Cardiol. 1969 Feb;23(2):208–216. doi: 10.1016/0002-9149(69)90068-x. [DOI] [PubMed] [Google Scholar]
- Blackshear J. L., O'Callaghan W. G., Califf R. M. Medical approaches to prevention of restenosis after coronary angioplasty. J Am Coll Cardiol. 1987 Apr;9(4):834–848. doi: 10.1016/s0735-1097(87)80240-1. [DOI] [PubMed] [Google Scholar]
- Brand F. N., Abbott R. D., Kannel W. B., Wolf P. A. Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study. JAMA. 1985 Dec 27;254(24):3449–3453. [PubMed] [Google Scholar]
- Breddin K., Loew D., Lechner K., Uberla K., Walter E. Secondary prevention of myocardial infarction. Comparison of acetylsalicylic acid, phenprocoumon and placebo. A multicenter two-year prospective study. Thromb Haemost. 1979 Feb 28;41(1):225–236. [PubMed] [Google Scholar]
- Carter B. L., Taylor J. W., Becker A. Evaluation of three dosage-prediction methods for initial in-hospital stabilization of warfarin therapy. Clin Pharm. 1987 Jan;6(1):37–45. [PubMed] [Google Scholar]
- Charney R., Leddomado E., Rose D. N., Fuster V. Anticoagulation clinics and the monitoring of anticoagulant therapy. Int J Cardiol. 1988 Feb;18(2):197–206. doi: 10.1016/0167-5273(88)90165-9. [DOI] [PubMed] [Google Scholar]
- Chesebro J. H., Fuster V., Elveback L. R., McGoon D. C., Pluth J. R., Puga F. J., Wallace R. B., Danielson G. K., Orszulak T. A., Piehler J. M. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol. 1983 May 15;51(9):1537–1541. doi: 10.1016/0002-9149(83)90673-2. [DOI] [PubMed] [Google Scholar]
- Cole M. S., Minifee P. K., Wolma F. J. Coumarin necrosis--a review of the literature. Surgery. 1988 Mar;103(3):271–277. [PubMed] [Google Scholar]
- Cuttino J. T., Jr, Clark R. L., Feaster S. H., Zwicke D. L. The evaluation of gross hematuria in anticoagulated patients: efficacy of i.v. urography and cystoscopy. AJR Am J Roentgenol. 1987 Sep;149(3):527–528. doi: 10.2214/ajr.149.3.527. [DOI] [PubMed] [Google Scholar]
- Davis F. B., Estruch M. T., Samson-Corvera E. B., Voigt G. C., Tobin J. D. Management of anticoagulation in outpatients: experience with an anticoagulation service in a municipal hospital setting. Arch Intern Med. 1977 Feb;137(2):197–202. [PubMed] [Google Scholar]
- DeSilva R. A., Graboys T. B., Podrid P. J., Lown B. Cardioversion and defibrillation. Am Heart J. 1980 Dec;100(6 Pt 1):881–895. doi: 10.1016/0002-8703(80)90071-x. [DOI] [PubMed] [Google Scholar]
- Deron S. J., Kotler M. N. Noncardiac surgery in the cardiac patient. Am Heart J. 1988 Sep;116(3):831–838. doi: 10.1016/0002-8703(88)90345-6. [DOI] [PubMed] [Google Scholar]
- Dixon J. E. Pregnancies complicated by previous thromboembolic disease. Br J Hosp Med. 1987 May;37(5):449–452. [PubMed] [Google Scholar]
- Doyle D. J., Turpie A. G., Hirsh J., Best C., Kinch D., Levine M. N., Gent M. Adjusted subcutaneous heparin or continuous intravenous heparin in patients with acute deep vein thrombosis. A randomized trial. Ann Intern Med. 1987 Oct;107(4):441–445. doi: 10.7326/0003-4819-107-4-441. [DOI] [PubMed] [Google Scholar]
- Drapkin A., Merskey C. Anticoagulant therapy after acute myocardial infarction. Relation of therapeutic benefit to patient's age, sex, and severity of infarction. JAMA. 1972 Oct 30;222(5):541–548. doi: 10.1001/jama.222.5.541. [DOI] [PubMed] [Google Scholar]
- Dukes G. E., Jr, Sanders S. W., Russo J., Jr, Swenson E., Burnakis T. G., Saffle J. R., Warden G. D. Transaminase elevations in patients receiving bovine or porcine heparin. Ann Intern Med. 1984 May;100(5):646–650. doi: 10.7326/0003-4819-100-5-646. [DOI] [PubMed] [Google Scholar]
- Dunn M., Alexander J., de Silva R., Hildner F. Antithrombotic therapy in atrial fibrillation. Chest. 1989 Feb;95(2 Suppl):118S–127S. doi: 10.1378/chest.95.2_supplement.118s. [DOI] [PubMed] [Google Scholar]
- Duxbury B. M. Therapeutic control of anticoagulant treatment. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):702–704. doi: 10.1136/bmj.284.6317.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Duxbury B. M. Therapeutic quality control leading to further clinical assessment of oral anticoagulation. Acta Haematol. 1986;76(2-3):65–67. doi: 10.1159/000206023. [DOI] [PubMed] [Google Scholar]
- Edes T. E., Sunderrajan E. V. Heparin-induced hyperkalemia. Arch Intern Med. 1985 Jun;145(6):1070–1072. [PubMed] [Google Scholar]
- Edmunds L. H., Jr Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg. 1987 Oct;44(4):430–445. doi: 10.1016/s0003-4975(10)63816-7. [DOI] [PubMed] [Google Scholar]
- Errichetti A. M., Holden A., Ansell J. Management of oral anticoagulant therapy. Experience with an anticoagulation clinic. Arch Intern Med. 1984 Oct;144(10):1966–1968. [PubMed] [Google Scholar]
- Everett R. N., Jones F. L., Jr Warfarin-induced skin necrosis. A cutaneous sign of malignancy? Postgrad Med. 1986 Feb 1;79(2):97–103. doi: 10.1080/00325481.1986.11699268. [DOI] [PubMed] [Google Scholar]
- Fennerty A., Campbell I. A., Routledge P. A. Anticoagulants in venous thromboembolism. BMJ. 1988 Nov 19;297(6659):1285–1288. doi: 10.1136/bmj.297.6659.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fennerty A., Dolben J., Thomas P., Backhouse G., Bentley D. P., Campbell I. A., Routledge P. A. Flexible induction dose regimen for warfarin and prediction of maintenance dose. Br Med J (Clin Res Ed) 1984 Apr 28;288(6426):1268–1270. doi: 10.1136/bmj.288.6426.1268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fine M. J., Kapoor W., Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987 Oct;38(10):769–784. doi: 10.1177/000331978703801007. [DOI] [PubMed] [Google Scholar]
- Flegel K. M., Shipley M. J., Rose G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet. 1987 Mar 7;1(8532):526–529. doi: 10.1016/s0140-6736(87)90174-7. [DOI] [PubMed] [Google Scholar]
- Forfar J. C. A 7-year analysis of haemorrhage in patients on long-term anticoagulant treatment. Br Heart J. 1979 Aug;42(2):128–132. doi: 10.1136/hrt.42.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fuster V., Badimon L., Badimon J. J., Chesebro J. Prevention of thromboembolism induced by prosthetic heart valves. Semin Thromb Hemost. 1988 Jan;14(1):50–58. doi: 10.1055/s-2007-1002755. [DOI] [PubMed] [Google Scholar]
- Fuster V., Gersh B. J., Giuliani E. R., Tajik A. J., Brandenburg R. O., Frye R. L. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol. 1981 Mar;47(3):525–531. doi: 10.1016/0002-9149(81)90534-8. [DOI] [PubMed] [Google Scholar]
- Fuster V., Stein B., Badimon L., Chesebro J. H. Antithrombotic therapy after myocardial reperfusion in acute myocardial infarction. J Am Coll Cardiol. 1988 Dec;12(6 Suppl A):78A–84A. doi: 10.1016/0735-1097(88)92644-7. [DOI] [PubMed] [Google Scholar]
- Gallus A., Jackaman J., Tillett J., Mills W., Wycherley A. Safety and efficacy of warfarin started early after submassive venous thrombosis or pulmonary embolism. Lancet. 1986 Dec 6;2(8519):1293–1296. doi: 10.1016/s0140-6736(86)91431-5. [DOI] [PubMed] [Google Scholar]
- Ginsberg J. S., Hirsh J. Optimum use of anticoagulants in pregnancy. Drugs. 1988 Oct;36(4):505–512. doi: 10.2165/00003495-198836040-00007. [DOI] [PubMed] [Google Scholar]
- Ginsberg J. S., Hirsh J. Use of anticoagulants during pregnancy. Chest. 1989 Feb;95(2 Suppl):156S–160S. doi: 10.1378/chest.95.2_supplement.156s. [DOI] [PubMed] [Google Scholar]
- Grotta J. C. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. 1987 Dec 10;317(24):1505–1516. doi: 10.1056/NEJM198712103172405. [DOI] [PubMed] [Google Scholar]
- Gurwitz J. H., Goldberg R. J., Holden A., Knapic N., Ansell J. Age-related risks of long-term oral anticoagulant therapy. Arch Intern Med. 1988 Aug;148(8):1733–1736. [PubMed] [Google Scholar]
- Hall J. G., Pauli R. M., Wilson K. M. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med. 1980 Jan;68(1):122–140. doi: 10.1016/0002-9343(80)90181-3. [DOI] [PubMed] [Google Scholar]
- Halperin J. L., Hart R. G. Atrial fibrillation and stroke: new ideas, persisting dilemmas. Stroke. 1988 Aug;19(8):937–941. doi: 10.1161/01.str.19.8.937. [DOI] [PubMed] [Google Scholar]
- Hirsh J., Hull R. D. Treatment of venous thromboembolism. Chest. 1986 May;89(5 Suppl):426S–433S. doi: 10.1378/chest.89.5_supplement.426s. [DOI] [PubMed] [Google Scholar]
- Hirsh J., Levine M. N. The optimal intensity of oral anticoagulant therapy. JAMA. 1987 Nov 20;258(19):2723–2726. [PubMed] [Google Scholar]
- Hirsh J., Levine M. Confusion over the therapeutic range for monitoring oral anticoagulant therapy in North America. Thromb Haemost. 1988 Apr 8;59(2):129–132. [PubMed] [Google Scholar]
- Holford N. H. Clinical pharmacokinetics and pharmacodynamics of warfarin. Understanding the dose-effect relationship. Clin Pharmacokinet. 1986 Nov-Dec;11(6):483–504. doi: 10.2165/00003088-198611060-00005. [DOI] [PubMed] [Google Scholar]
- Holmgren K., Andersson G., Fagrell B., Johnsson H., Ljungberg B., Nilsson E., Wilhelmsson S., Zetterquist S. One-month versus six-month therapy with oral anticoagulants after symptomatic deep vein thrombosis. Acta Med Scand. 1985;218(3):279–284. doi: 10.1111/j.0954-6820.1985.tb06125.x. [DOI] [PubMed] [Google Scholar]
- Howard M. R., Milligan D. W. Frequency of attendance at anticoagulant clinics. Acta Haematol. 1986;76(2-3):78–80. doi: 10.1159/000206025. [DOI] [PubMed] [Google Scholar]
- Howard M. R., Milligan D. W. Frequency of attendance at anticoagulant clinics: a prospective study. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):898–899. doi: 10.1136/bmj.296.6626.898-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Huisman M. V., Büller H. R., ten Cate J. W., Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. The Amsterdam General Practitioner Study. N Engl J Med. 1986 Mar 27;314(13):823–828. doi: 10.1056/NEJM198603273141305. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Carter C. J., Jay R. M., Ockelford P. A., Hirsch J., Turpie A. G., Zielinsky A., Gent M., Powers P. J. The diagnosis of acute, recurrent, deep-vein thrombosis: a diagnostic challenge. Circulation. 1983 Apr;67(4):901–906. doi: 10.1161/01.cir.67.4.901. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Hirsh J., Carter C. J., Jay R. M., Ockelford P. A., Buller H. R., Turpie A. G., Powers P., Kinch D., Dodd P. E. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann Intern Med. 1985 Jan;102(1):21–28. doi: 10.7326/0003-4819-102-1-21. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Raskob G. E., Hirsh J., Jay R. M., Leclerc J. R., Geerts W. H., Rosenbloom D., Sackett D. L., Anderson C., Harrison L. Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. N Engl J Med. 1986 Oct 30;315(18):1109–1114. doi: 10.1056/NEJM198610303151801. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Raskob G. E., Hirsh J., Sackett D. L. A cost-effectiveness analysis of alternative approaches for long-term treatment of proximal venous thrombosis. JAMA. 1984 Jul 13;252(2):235–239. [PubMed] [Google Scholar]
- Hull R. D., Raskob G. E., LeClerc J. R., Jay R. M., Hirsh J. The diagnosis of clinically suspected venous thrombosis. Clin Chest Med. 1984 Sep;5(3):439–456. [PubMed] [Google Scholar]
- Hull R., Delmore T., Carter C., Hirsh J., Genton E., Gent M., Turpie G., McLaughlin D. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med. 1982 Jan 28;306(4):189–194. doi: 10.1056/NEJM198201283060401. [DOI] [PubMed] [Google Scholar]
- Hull R., Delmore T., Genton E., Hirsh J., Gent M., Sackett D., McLoughlin D., Armstrong P. Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med. 1979 Oct 18;301(16):855–858. doi: 10.1056/NEJM197910183011602. [DOI] [PubMed] [Google Scholar]
- Hull R., Hirsh J., Jay R., Carter C., England C., Gent M., Turpie A. G., McLoughlin D., Dodd P., Thomas M. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med. 1982 Dec 30;307(27):1676–1681. doi: 10.1056/NEJM198212303072704. [DOI] [PubMed] [Google Scholar]
- Hull R., Hirsh J. Long-term anticoagulant therapy in patients with venous thrombosis. Arch Intern Med. 1983 Nov;143(11):2061–2063. [PubMed] [Google Scholar]
- Husted S., Andreasen F. The influence of age on the response to anticoagulants. Br J Clin Pharmacol. 1977 Oct;4(5):559–565. doi: 10.1111/j.1365-2125.1977.tb00786.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hyman B. T., Landas S. K., Ashman R. F., Schelper R. L., Robinson R. A. Warfarin-related purple toes syndrome and cholesterol microembolization. Am J Med. 1987 Jun;82(6):1233–1237. doi: 10.1016/0002-9343(87)90231-2. [DOI] [PubMed] [Google Scholar]
- Jaffin B. W., Bliss C. M., LaMont J. T. Significance of occult gastrointestinal bleeding during anticoagulation therapy. Am J Med. 1987 Aug;83(2):269–272. doi: 10.1016/0002-9343(87)90697-8. [DOI] [PubMed] [Google Scholar]
- Johannessen K. A., Nordrehaug J. E., von der Lippe G., Vollset S. E. Risk factors for embolisation in patients with left ventricular thrombi and acute myocardial infarction. Br Heart J. 1988 Aug;60(2):104–110. doi: 10.1136/hrt.60.2.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johannessen K. A., Stratton J. R., Taulow E., Osterud B., von der Lippe G. Usefulness of aspirin plus dipyridamole in reducing left ventricular thrombus formation in anterior wall acute myocardial infarction. Am J Cardiol. 1989 Jan 1;63(1):101–102. doi: 10.1016/0002-9149(89)91085-0. [DOI] [PubMed] [Google Scholar]
- Jonas S. Anticoagulant therapy in cerebrovascular disease: review and meta-analysis. Stroke. 1988 Aug;19(8):1043–1048. doi: 10.1161/01.str.19.8.1043. [DOI] [PubMed] [Google Scholar]
- Jupe D. M., Peterson G. M., Coleman R. L., McLean S. Warfarin dosage requirements: prospective clinical trial of a method for prediction from the response to a single dose. Br J Clin Pharmacol. 1988 May;25(5):607–610. doi: 10.1111/j.1365-2125.1988.tb03353.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Karlson B., Leijd B., Hellström K. On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment. Acta Med Scand. 1986;220(4):347–350. doi: 10.1111/j.0954-6820.1986.tb02776.x. [DOI] [PubMed] [Google Scholar]
- Katholi R. E., Nolan S. P., McGuire L. B. Living with prosthetic heart valves. Subsequent noncardiac operations and the risk of thromboembolism or hemorrhage. Am Heart J. 1976 Aug;92(2):162–167. doi: 10.1016/s0002-8703(76)80251-7. [DOI] [PubMed] [Google Scholar]
- Katholi R. E., Nolan S. P., McGuire L. B. The management of anticoagulation during noncardiac operations in patients with prosthetic heart valves. A prospective study. Am Heart J. 1978 Aug;96(2):163–165. doi: 10.1016/0002-8703(78)90080-7. [DOI] [PubMed] [Google Scholar]
- Kewenter J., Svanvik J., Svensson C., Wållgren K. The diagnostic value of the hemoccult as a screening test in patients taking anticoagulants. Cancer. 1984 Dec 15;54(12):3054–3058. doi: 10.1002/1097-0142(19841215)54:12<3054::aid-cncr2820541240>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
- Kopecky S. L., Gersh B. J., McGoon M. D., Whisnant J. P., Holmes D. R., Jr, Ilstrup D. M., Frye R. L. The natural history of lone atrial fibrillation. A population-based study over three decades. N Engl J Med. 1987 Sep 10;317(11):669–674. doi: 10.1056/NEJM198709103171104. [DOI] [PubMed] [Google Scholar]
- Krauth D., Holden A., Knapic N., Liepman M., Ansell J. Safety and efficacy of long-term oral anticoagulation in cancer patients. Cancer. 1987 Mar 1;59(5):983–985. doi: 10.1002/1097-0142(19870301)59:5<983::aid-cncr2820590522>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
- Kwong P., Roberts P., Prescott S. M., Tikoff G. Dermatitis induced by warfarin. JAMA. 1978 May 5;239(18):1884–1885. [PubMed] [Google Scholar]
- Kyrle P. A., Korninger C., Gössinger H., Glogar D., Lechner K., Niessner H., Pabinger I. Prevention of arterial and pulmonary embolism by oral anticoagulants in patients with dilated cardiomyopathy. Thromb Haemost. 1985 Aug 30;54(2):521–523. [PubMed] [Google Scholar]
- Lagerstedt C. I., Olsson C. G., Fagher B. O., Oqvist B. W., Albrechtsson U. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet. 1985 Sep 7;2(8454):515–518. doi: 10.1016/s0140-6736(85)90459-3. [DOI] [PubMed] [Google Scholar]
- Landefeld C. S., Cook E. F., Flatley M., Weisberg M., Goldman L. Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy. Am J Med. 1987 Apr;82(4):703–713. doi: 10.1016/0002-9343(87)90004-0. [DOI] [PubMed] [Google Scholar]
- Landefeld C. S., Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989 Aug;87(2):144–152. doi: 10.1016/s0002-9343(89)80689-8. [DOI] [PubMed] [Google Scholar]
- Lapeyre A. C., 3rd, Steele P. M., Kazmier F. J., Chesebro J. H., Vlietstra R. E., Fuster V. Systemic embolism in chronic left ventricular aneurysm: incidence and the role of anticoagulation. J Am Coll Cardiol. 1985 Sep;6(3):534–538. doi: 10.1016/s0735-1097(85)80109-1. [DOI] [PubMed] [Google Scholar]
- Lee P. K., Wang R. Y., Chow J. S., Cheung K. L., Wong V. C., Chan T. K. Combined use of warfarin and adjusted subcutaneous heparin during pregnancy in patients with an artificial heart valve. J Am Coll Cardiol. 1986 Jul;8(1):221–224. doi: 10.1016/s0735-1097(86)80116-4. [DOI] [PubMed] [Google Scholar]
- Lensing A. W., Prandoni P., Brandjes D., Huisman P. M., Vigo M., Tomasella G., Krekt J., Wouter Ten Cate J., Huisman M. V., Büller H. R. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989 Feb 9;320(6):342–345. doi: 10.1056/NEJM198902093200602. [DOI] [PubMed] [Google Scholar]
- Levine H. J., Pauker S. G., Salzman E. W. Antithrombotic therapy in valvular heart disease. Chest. 1989 Feb;95(2 Suppl):98S–106S. doi: 10.1378/chest.95.2_supplement.98s. [DOI] [PubMed] [Google Scholar]
- Levine L. E., Bernstein J. E., Soltani K., Medenica M. M., Yung C. W. Heparin-induced cutaneous necrosis unrelated to injection sites. A sign of potentially lethal complications. Arch Dermatol. 1983 May;119(5):400–403. [PubMed] [Google Scholar]
- Levine M. N., Hirsh J. Hemorrhagic complications of anticoagulant therapy. Semin Thromb Hemost. 1986 Jan;12(1):39–57. doi: 10.1055/s-2007-1003533. [DOI] [PubMed] [Google Scholar]
- Levine M. N., Raskob G., Hirsh J. Hemorrhagic complications of long-term anticoagulant therapy. Chest. 1989 Feb;95(2 Suppl):26S–36S. doi: 10.1378/chest.95.2_supplement.26s. [DOI] [PubMed] [Google Scholar]
- Lodder J., Dennis M. S., Van Raak L., Jones L. N., Warlow C. P. Cooperative study on the value of long term anticoagulation in patients with stroke and non-rheumatic atrial fibrillation. Br Med J (Clin Res Ed) 1988 May 21;296(6634):1435–1438. doi: 10.1136/bmj.296.6634.1435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Loeliger E. A. Laboratory control, optimal therapeutic ranges and therapeutic quality control in oral anticoagulation. Acta Haematol. 1985;74(3):125–131. doi: 10.1159/000206187. [DOI] [PubMed] [Google Scholar]
- Lutomski D. M., Djuric P. E., Draeger R. W. Warfarin therapy. The effect of heparin on prothrombin times. Arch Intern Med. 1987 Mar;147(3):432–433. doi: 10.1001/archinte.147.3.432. [DOI] [PubMed] [Google Scholar]
- Mancini G. B., Goldberger A. L. Cardioversion of atrial fibrillation: consideration of embolization, anticoagulation, prophylactic pacemaker, and long-term success. Am Heart J. 1982 Sep;104(3):617–621. doi: 10.1016/0002-8703(82)90236-8. [DOI] [PubMed] [Google Scholar]
- McCance A. J., Taylor D. N. Incidence of asymptomatic pulmonary embolus following acute myocardial infarction. Eur Heart J. 1987 Apr;8(4):360–361. doi: 10.1093/oxfordjournals.eurheartj.a062286. [DOI] [PubMed] [Google Scholar]
- McKenna R., Cole E. R., Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr. 1983 Aug;103(2):325–327. doi: 10.1016/s0022-3476(83)80378-3. [DOI] [PubMed] [Google Scholar]
- McKernan A., Thomson J. M., Poller L. The reliability of international normalized ratios during short-term oral anticoagulant treatment. Clin Lab Haematol. 1988;10(1):63–71. doi: 10.1111/j.1365-2257.1988.tb01154.x. [DOI] [PubMed] [Google Scholar]
- Mungall D. R., Ludden T. M., Marshall J., Hawkins D. W., Talbert R. L., Crawford M. H. Population pharmacokinetics of racemic warfarin in adult patients. J Pharmacokinet Biopharm. 1985 Jun;13(3):213–227. doi: 10.1007/BF01065653. [DOI] [PubMed] [Google Scholar]
- Neri Serneri G. G., Rovelli F., Gensini G. F., Pirelli S., Carnovali M., Fortini A. Effectiveness of low-dose heparin in prevention of myocardial reinfarction. Lancet. 1987 Apr 25;1(8539):937–942. doi: 10.1016/s0140-6736(87)90291-1. [DOI] [PubMed] [Google Scholar]
- O'Callaghan J. W., Thompson R. N., Russell A. S. Combining NSAIDs with anticoagulants: yes and no. Can Med Assoc J. 1984 Oct 15;131(8):857–859. [PMC free article] [PubMed] [Google Scholar]
- O'Malley K., Stevenson I. H., Ward C. A., Wood A. J., Crooks J. Determinants of anticoagulant control in patients receiving warfarin. Br J Clin Pharmacol. 1977 Jun;4(3):309–314. doi: 10.1111/j.1365-2125.1977.tb00718.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Reilly R. A., Aggeler P. M. Studies on coumarin anticoagulant drugs. Initiation of warfarin therapy without a loading dose. Circulation. 1968 Jul;38(1):169–177. doi: 10.1161/01.cir.38.1.169. [DOI] [PubMed] [Google Scholar]
- Oakley C. Valve prostheses and pregnancy. Br Heart J. 1987 Oct;58(4):303–305. doi: 10.1136/hrt.58.4.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pauker S. G., Eckman M. H., Levine H. J. A decision analytic view of anticoagulant prophylaxis for thromboembolism in heart disease. Chest. 1989 Feb;95(2 Suppl):161S–169S. doi: 10.1378/chest.95.2_supplement.161s. [DOI] [PubMed] [Google Scholar]
- Petersen P., Boysen G., Godtfredsen J., Andersen E. D., Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989 Jan 28;1(8631):175–179. doi: 10.1016/s0140-6736(89)91200-2. [DOI] [PubMed] [Google Scholar]
- Petersen P., Godtfredsen J. Risk factors for stroke in chronic atrial fibrillation. Eur Heart J. 1988 Mar;9(3):291–294. doi: 10.1093/oxfordjournals.eurheartj.a062499. [DOI] [PubMed] [Google Scholar]
- Petitti D. B., Strom B. L., Melmon K. L. Duration of warfarin anticoagulant therapy and the probabilities of recurrent thromboembolism and hemorrhage. Am J Med. 1986 Aug;81(2):255–259. doi: 10.1016/0002-9343(86)90260-3. [DOI] [PubMed] [Google Scholar]
- Petty G. W., Lennihan L., Mohr J. P., Hauser W. A., Weitz J., Owen J., Towey C. Complications of long-term anticoagulation. Ann Neurol. 1988 Jun;23(6):570–574. doi: 10.1002/ana.410230607. [DOI] [PubMed] [Google Scholar]
- Philbrick J. T., Becker D. M. Calf deep venous thrombosis. A wolf in sheep's clothing? Arch Intern Med. 1988 Oct;148(10):2131–2138. [PubMed] [Google Scholar]
- Poller L. A simple nomogram for the derivation of international normalised ratios for the standardisation of prothrombin times. Thromb Haemost. 1988 Aug 30;60(1):18–20. [PubMed] [Google Scholar]
- Powers L. R. Distal deep vein thrombosis: what's the best treatment? J Gen Intern Med. 1988 May-Jun;3(3):288–293. doi: 10.1007/BF02596345. [DOI] [PubMed] [Google Scholar]
- Rhodes R. S., Rhodes P. J., Klein C., Sintek C. D. A warfarin-piroxicam drug interaction. Drug Intell Clin Pharm. 1985 Jul-Aug;19(7-8):556–558. doi: 10.1177/106002808501900711. [DOI] [PubMed] [Google Scholar]
- Richmond R. G., Sawyer W. T., Aiello P. D., Lindley C. M. Extreme warfarin intoxication secondary to possible covert drug ingestion. Drug Intell Clin Pharm. 1988 Sep;22(9):696–699. doi: 10.1177/106002808802200910. [DOI] [PubMed] [Google Scholar]
- Richton-Hewett S., Foster E., Apstein C. S. Medical and economic consequences of a blinded oral anticoagulant brand change at a municipal hospital. Arch Intern Med. 1988 Apr;148(4):806–808. [PubMed] [Google Scholar]
- Roddie A. M., Pollock A. Therapeutic control of anticoagulation: how important is patient education? Clin Lab Haematol. 1988;10(1):109–112. [PubMed] [Google Scholar]
- Rosiello R. A., Chan C. K., Tencza F., Matthay R. A. Timing of oral anticoagulation therapy in the treatment of angiographically proven acute pulmonary embolism. Arch Intern Med. 1987 Aug;147(8):1469–1473. [PubMed] [Google Scholar]
- Routledge P. A., Chapman P. H., Davies D. M., Rawlins M. D. Factors affecting warfarin requirements. A prospective population study. Eur J Clin Pharmacol. 1979 Jun 12;15(5):319–322. doi: 10.1007/BF00558434. [DOI] [PubMed] [Google Scholar]
- Routledge P. A. The Smith Kline & French lecture 1987. Clinical pharmacology and the art of bespoke prescribing. Br J Clin Pharmacol. 1988 Oct;26(4):339–345. doi: 10.1111/j.1365-2125.1988.tb03390.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scheinberg P. Controversies in the management of cerebral vascular disease. Neurology. 1988 Oct;38(10):1609–1616. doi: 10.1212/wnl.38.10.1609. [DOI] [PubMed] [Google Scholar]
- Schuster G. A., Lewis G. A. Clinical significance of hematuria in patients on anticoagulant therapy. J Urol. 1987 May;137(5):923–925. doi: 10.1016/s0022-5347(17)44295-9. [DOI] [PubMed] [Google Scholar]
- Schwartz K. A., Royer G., Kaufman D. B., Penner J. A. Complications of heparin administration in normal individuals. Am J Hematol. 1985 Aug;19(4):355–363. doi: 10.1002/ajh.2830190406. [DOI] [PubMed] [Google Scholar]
- Sherman D. G., Dyken M. L., Fisher M., Harrison M. J., Hart R. G. Antithrombotic therapy for cerebrovascular disorders. Chest. 1989 Feb;95(2 Suppl):140S–155S. doi: 10.1378/chest.95.2_supplement.140s. [DOI] [PubMed] [Google Scholar]
- Sherman R. A., Ruddy M. C. Suppression of aldosterone production by low-dose heparin. Am J Nephrol. 1986;6(3):165–168. doi: 10.1159/000167106. [DOI] [PubMed] [Google Scholar]
- Stein P. D., Kantrowitz A. Antithrombotic therapy in mechanical and biological prosthetic heart valves and saphenous vein bypass grafts. Chest. 1989 Feb;95(2 Suppl):107S–117S. doi: 10.1378/chest.95.2_supplement.107s. [DOI] [PubMed] [Google Scholar]
- Stratton J. R., Nemanich J. W., Johannessen K. A., Resnick A. D. Fate of left ventricular thrombi in patients with remote myocardial infarction or idiopathic cardiomyopathy. Circulation. 1988 Dec;78(6):1388–1393. doi: 10.1161/01.cir.78.6.1388. [DOI] [PubMed] [Google Scholar]
- Stratton J. R., Resnick A. D. Increased embolic risk in patients with left ventricular thrombi. Circulation. 1987 May;75(5):1004–1011. doi: 10.1161/01.cir.75.5.1004. [DOI] [PubMed] [Google Scholar]
- Thornton M. A., Gruentzig A. R., Hollman J., King S. B., 3rd, Douglas J. S. Coumadin and aspirin in prevention of recurrence after transluminal coronary angioplasty: a randomized study. Circulation. 1984 Apr;69(4):721–727. doi: 10.1161/01.cir.69.4.721. [DOI] [PubMed] [Google Scholar]
- Tinker J. H., Tarhan S. Discontinuing anticoagulant therapy in surgical patients with cardiac valve prostheses. Observations in 180 operations. JAMA. 1978 Feb 20;239(8):738–739. [PubMed] [Google Scholar]
- Tramarin R., Pozzoli M., Febo O., Opasich C., Colombo E., Cobelli F., Specchia G. Two-dimensional echocardiographic assessment of anticoagulant therapy in left ventricular thrombosis early after acute myocardial infarction. Eur Heart J. 1986 Jun;7(6):482–492. doi: 10.1093/oxfordjournals.eurheartj.a062095. [DOI] [PubMed] [Google Scholar]
- Tuneu A., Moreno A., de Moragas J. M. Cutaneous reactions secondary to heparin injections. J Am Acad Dermatol. 1985 Jun;12(6):1072–1077. doi: 10.1016/s0190-9622(85)70135-1. [DOI] [PubMed] [Google Scholar]
- Turpie A. G., Gunstensen J., Hirsh J., Nelson H., Gent M. Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet. 1988 Jun 4;1(8597):1242–1245. doi: 10.1016/s0140-6736(88)92070-3. [DOI] [PubMed] [Google Scholar]
- Urban P., Buller N., Fox K., Shapiro L., Bayliss J., Rickards A. Lack of effect of warfarin on the restenosis rate or on clinical outcome after balloon coronary angioplasty. Br Heart J. 1988 Dec;60(6):485–488. doi: 10.1136/hrt.60.6.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walker M. G., Shaw J. W., Thomson G. J., Cumming J. G., Thomas M. L. Subcutaneous calcium heparin versus intravenous sodium heparin in treatment of established acute deep vein thrombosis of the legs: a multicentre prospective randomised trial. Br Med J (Clin Res Ed) 1987 May 9;294(6581):1189–1192. doi: 10.1136/bmj.294.6581.1189. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weinberger J., Rothlauf E., Materese E., Halperin J. Noninvasive evaluation of the extracranial carotid arteries in patients with cerebrovascular events and atrial fibrillations. Arch Intern Med. 1988 Aug;148(8):1785–1788. [PubMed] [Google Scholar]
- Weinreich D. J., Burke J. F., Pauletto F. J. Left ventricular mural thrombi complicating acute myocardial infarction. Long-term follow-up with serial echocardiography. Ann Intern Med. 1984 Jun;100(6):789–794. doi: 10.7326/0003-4819-100-6-789. [DOI] [PubMed] [Google Scholar]
- Weiss P., Halkin H., Almog S. The negative impact of biological variation in the effect and clearance of warfarin on methods for prediction of dose requirements. Thromb Haemost. 1986 Dec 15;56(3):371–375. [PubMed] [Google Scholar]
- White R. H., Hong R., Venook A. P., Daschbach M. M., Murray W., Mungall D. R., Coleman R. W. Initiation of warfarin therapy: comparison of physician dosing with computer-assisted dosing. J Gen Intern Med. 1987 May-Jun;2(3):141–148. doi: 10.1007/BF02596140. [DOI] [PubMed] [Google Scholar]
- Wiener I. Clinical and echocardiographic correlates of systemic embolization in nonrheumatic atrial fibrillation. Am J Cardiol. 1987 Jan 1;59(1):177–177. doi: 10.1016/s0002-9149(87)80102-9. [DOI] [PubMed] [Google Scholar]
- Wilcox C. M., Truss C. D. Gastrointestinal bleeding in patients receiving long-term anticoagulant therapy. Am J Med. 1988 Apr;84(4):683–690. doi: 10.1016/0002-9343(88)90105-2. [DOI] [PubMed] [Google Scholar]
- Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987 Sep;147(9):1561–1564. [PubMed] [Google Scholar]
- Yatsu F. M., Hart R. G., Mohr J. P., Grotta J. C. Anticoagulation of embolic strokes of cardiac origin: an update. Neurology. 1988 Feb;38(2):314–316. doi: 10.1212/wnl.38.2.314. [DOI] [PubMed] [Google Scholar]
- Zimran A., Shilo S., Fisher D., Bab I. Histomorphometric evaluation of reversible heparin-induced osteoporosis in pregnancy. Arch Intern Med. 1986 Feb;146(2):386–388. [PubMed] [Google Scholar]
- de Swiet M. Anticoagulants. Br Med J (Clin Res Ed) 1987 Feb 14;294(6569):428–430. doi: 10.1136/bmj.294.6569.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
- de Swiet M., Ward P. D., Fidler J., Horsman A., Katz D., Letsky E., Peacock M., Wise P. H. Prolonged heparin therapy in pregnancy causes bone demineralization. Br J Obstet Gynaecol. 1983 Dec;90(12):1129–1134. doi: 10.1111/j.1471-0528.1983.tb06459.x. [DOI] [PubMed] [Google Scholar]
