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Walter Ageno - One of the best experts on this subject based on the ideXlab platform.

  • Incidence of thromboembolic complications in patients with mechanical heart valves with a subtherapeutic International Normalized Ratio.
    The Journal of thoracic and cardiovascular surgery, 2008
    Co-Authors: Francesco Dentali, Nicoletta Riva, Alessandra Malato, Giorgia Saccullo, Sergio Siragusa, Walter Ageno
    Abstract:

    Objective Subtherapeutic International Normalized Ratios are frequently encountered in clinical practice, and patients with mechanical heart valves with inadequate anticoagulation may be exposed to an increased risk of thromboembolic events. There are no data on thromboembolic event risk for these patients. Methods We assessed the current practice patterns in the management of patients with mechanical heart valves with subtherapeutic International Normalized Ratios and assessed the risk of thromboembolic complications in this setting. The charts of patients with mechanical heart valves followed up in two anticoagulation clinics were reviewed. Patients with a history of stable, therapeutic anticoagulation but with a subtherapeutic International Normalized Ratio were included. Patients who underwent invasive procedures requiring temporary suspension of antithrombotic therapy were excluded. Data on use and dose of low–molecular weight heparin bridging therapy were collected. Results The incidence of objectively confirmed thromboembolic events within 90 days after obtaining the index International Normalized Ratio was assessed. Two hundred ninety-four patients with mechanical heart valves were included (mean age 63.3 years, 47.3% male). Low–molecular weight heparin was prescribed in 14 cases (4.8%). At 90 days, 1 patient had a thromboembolic complication (0.3%, 95% confidence interval 0%–1.9%). Conclusion Patients with previously stable, therapeutic anticoagulation with a subtherapeutic International Normalized Ratio have a low risk of thromboembolic events. Withholding low–molecular weight heparin bridging therapy is a reasonable therapeutic option in these cases.

  • Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy
    Annals of Internal Medicine, 2002
    Co-Authors: Mark Crowther, James D. Douketis, Terri Schnurr, Luigi Steidl, Valentina Mera, Carolina Ultori, Achille Venco, Walter Ageno
    Abstract:

    Oral vitamin K lowers the International Normalized Ratio more rapidly than subcutaneous vitamin K in asymptomatic patients who had supratherapeutic International Normalized Ratio values while recei...

Mark Crowther - One of the best experts on this subject based on the ideXlab platform.

Douglas B. Nelson - One of the best experts on this subject based on the ideXlab platform.

  • Acute GI Bleeding in the Setting of Supratherapeutic International Normalized Ratio in Patients Taking Warfarin: Endoscopic Diagnosis, Clinical Management, and Outcomes
    Gastrointestinal endoscopy, 2003
    Co-Authors: Timothy A. Rubin, Maureen Murdoch, Douglas B. Nelson
    Abstract:

    Abstract Background: Acute GI bleeding is a life-threatening complication of warfarin therapy. Acute GI bleeding in patients with an International Normalized Ratio of 4.0 or greater (supratherapeutic) is often attributed to trivial mucosal lesions. The aim of the study was to determine the frequency of potentially significant lesions that would warrant endoscopy in this setting. Methods: A retrospective review was conducted of patients treated with warfarin who were admitted to a single Veterans Affairs hospital from 1996 to 2000 with acute GI bleeding. Endoscopic findings, clinical management, and outcomes are reviewed for patients with a supratherapeutic International Normalized Ratio (≥4.0) and compared with patients with an International Normalized Ratio in the therapeutic range (2.0-3.9). Results: Fifty-five patients with an International Normalized Ratio of 4.0 or greater (mean 8.4 [3.9]) and 43 patients with an International Normalized Ratio between 2.0 and 3.9 (mean 2.9 [0.6]) were hospitalized with acute GI bleeding. Thirty-seven patients (67%) with a supratherapeutic International Normalized Ratio and GI bleeding underwent upper endoscopy. Of these, 81.1% had positive findings, 18.9% had peptic ulcer disease, and 7.2% required endoscopic treatment. Thirty-eight percent of the patients with a supratherapeutic International Normalized Ratio underwent lower endoscopy; of these, 57.1% had abnormal findings and 9.5% required endoscopic treatment. Four patients (7.3%) in the supratherapeutic International Normalized Ratio group died during the index hospitalization. When patients with GI bleeding and a therapeutic International Normalized Ratio were compared with those with a supratherapeutic International Normalized Ratio, there were no significant differences between the two groups with regard to days of hospitalization, units of blood transfused, frequency of recurrent bleeding, need for surgery, or in-hospital deaths. Conclusions: The high frequency of clinically significant lesions in patients taking warfarin with an International Normalized Ratio in the supratherapeutic range and acute GI bleeding supports a role for endoscopic evaluation.

James D. Douketis - One of the best experts on this subject based on the ideXlab platform.

George L Tzanis - One of the best experts on this subject based on the ideXlab platform.

  • warfarin what are the clinical implications of an out of range therapeutic International Normalized Ratio
    Journal of Thrombosis and Thrombolysis, 2009
    Co-Authors: Geno J Merli, George L Tzanis
    Abstract:

    Warfarin is a commonly used oral anticoagulant, and has well-established clinical efficacy. However, it has a narrow therapeutic window, and a mode-of-action affected by inter-individual differences and environmental factors. The effectiveness and safety of warfarin are closely related to maintenance of the International Normalized Ratio (INR) within therapeutic range. A supra-therapeutic INR puts patients at risk of bleeding, whereas a sub-therapeutic INR may not protect against thromboembolic complications. Research suggests a lack of anticoagulation control during warfarin therapy in different settings. Careful monitoring of the INR is essential, especially in geriatric or cancer populations who are at an increased risk of major hemorrhage. Warfarin is an effective treatment but optimization of the risk-benefit Ratio is crucial in order to maximize efficacy and safety. Here, we will assess the extent to which INRs are an issue in the management of warfarin therapy, and the effect INRs may have on clinical outcomes.