Anticoagulants After Myocardial Infarction

Loeliger, E.A.; Roos, J; Tijssen, Jan G.P.; Vries, Willem A. de

doi:10.1016/s0140-6736(81)92500-9

Cited by 14 publications

(3 citation statements)

References 5 publications

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“…In several comparative studies it has been reported that acenocoumarol therapy results more often in anticoagulant situations beyond the therapeutic range than is observed for phenprocoumon therapy (22,23).Whether this can be ascribed to the 24-h fluctuations in coagulation factor synthesis as described in this study is hard to argue. Because of the absence of Thrombotest fluctations, misinterpretation of this parameter can neither be the cause of these reports.…”

Section: Discussionmentioning

confidence: 56%

4-Hydroxycoumarin Oral Anticoagulants : Pharmacokinetics-Response Relationship

1988

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SummaryThe blood coagulating factors II and VII and prothrombin times (Thrombotest) were followed during a dosage interval (= 24 h) in patients on acenocoumarol (n = 6) and on phenprocoumon (n = 6) therapy. The patients were on stable anti-coagulation (%TT: 7-13%) for at least 6 months. The study was performed to investigate the concentration-response relationship of the 4-hydroxycoumarin-type oral anticoagulants. The three parameters were stable during the 24-h interval for patients on phenprocoumon therapy. Patients on acenoumarol showed fluctuations in their factor VII levels; peak activities were observed at about 2 h, trough activities at about 16 h after acenocoumarol intake. Factor II and Thrombotest activities were stable. Plasma levels of phenprocoumon were stable during daytime whereas acenocoumarol levels declined exponentially (t½ about 12 h). The results indicate the oral anticoagulants to exhibit a concentration-response relationship common to drug-receptor interactions. The results also suggest that for stable and long-lasting anticoagulant therapy oral anticoagulants with half-lives beyond the dosage interval (t½>24 h) should be preferred.

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Section: Discussionmentioning

confidence: 56%

4-Hydroxycoumarin Oral Anticoagulants : Pharmacokinetics-Response Relationship

1988

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“…Moreover, results obtained in trials referred to as withdrawal studies [37][38][39] are similar to those obtained with contin uation studies [40][41][42][43][44] and a study done in patients suffering from angina pectoris [45], A synopsis of this material has recently been presented elsewhere [46], Equivocal results obtained with oral anti coagulation in myocardial infarction suggest that it is much harder to lower the rate of arterial thrombosis than to depress the rate of venous or intracardiac thrombosis. Reduc tion of the incidence of arterial thrombosis by 90% would seem to require the institution of INRs of 6-7, which of course would not be justifiable because of the severity of the bleed ing tendency under such conditions [47]. Figure 4 gives a schematic overall repre sentation of the relation between intensity of oral anticoagulation and clinical results.…”

Section: Arterial Thrombosismentioning

confidence: 99%

Optimal Therapeutic Anticoagulation

Loeliger¹

1985

Pathophysiol Haemos Thromb

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The relevant literature on the intensity of anticoagulation needed to prevent the development or growth of thrombi in patients at risk is reviewed. In case of elective surgery, prevention of venous thrombosis is easily attained with heparin or with coumarin alone, at levels of anticoagulation involving only a minor risk of bleeding complications. For posttraumatic prophylaxis, more intensive oral anticoagulation is required, similar to that for the management of active venous thrombosis, for which a combined heparin/coumarin regimen is proposed. A 90% reduction of the incidence of systemic emboli in patients with a high risk of developing intracardiac thrombosis requires high-intensity treatment with a target INR of 4. More intensive anticoagulation would be needed to obtain the same 90% protection in case of arterial (coronary) thrombosis. This is prohibited, however, by the rapidly increasing bleeding risk in cases with INR values > 5. With a target INR of 3.5 (sixty-Plus patients), the reinfarction rate will not be lowered by more than two thirds. Antiplatelet drugs given alone or in combination with anticoagulants have not been convincingly successful thus far in the prevention and treatment of thrombosis.

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“…[7][8][9][10][11][12] There is, however, to date only limited knowledge as to the beneficial effect of carotid endarterectomy in asymptomatic lesions.13"14 In contrast, it has been demonstrated that long-term anticoagulant therapy implemented by a specialized organiza-tion may reduce the risk of cardiovascular events, including myocardial infarction and stroke. [15][16][17][18] Information on the long-term risk of fatal and nonfatal stroke in patients with chronic limb ischemia is, however, limited.19~23 None of the studies have included multivariate analyses for the identification of patients who are at particular risk, and only one23 has expressed the risk of stroke as a life-table or survival curve.…”

mentioning

confidence: 99%

Ischemic and hemorrhagic stroke in patients on oral anticoagulants after reconstruction for chronic lower limb ischemia.

Dawson

Bockel

Ferrari

et al. 1993

Stroke

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Background and Purpose: Information on the long-term fate of patients with chronic lower limb ischemia is limited. We investigated the long-term risk of the first ischemic and hemorrhagic cerebral stroke in patients on long-term anticoagulant therapy after reconstruction for chronic limb ischemia.Methods: In a retrospective study, 376 consecutive patients were seen at regular intervals according to a standard protocol. Only 3 (0.7%) were lost during follow-up (mean duration, 5.9 years). Anticoagulation was with coumarin derivatives followed by prothrombin times periodically. Primary end points were ischemic and hemorrhagic cerebral stroke events, which were confirmed by CT scan, autopsy, or operation in 85% of the cases. Major vascular events were analyzed as a composite secondary end point. The influence of several clinical variables on these outcome events was evaluated in univariate and multivariate analyses.Results: Thirty-nine patients (10%1) had 41 stroke events (23 ischemic, 18 hemorrhagic); 22 of these patients (56%) died from stroke. The cumulative ischemic stroke risk was 5% at 5 years and 12% at 15 years. Prior myocardial infarction was the only independent predictor (relative risk [RR], 3.1; P<.05).

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Anticoagulants After Myocardial Infarction

Cited by 14 publications

References 5 publications

4-Hydroxycoumarin Oral Anticoagulants : Pharmacokinetics-Response Relationship

4-Hydroxycoumarin Oral Anticoagulants : Pharmacokinetics-Response Relationship

Optimal Therapeutic Anticoagulation

Ischemic and hemorrhagic stroke in patients on oral anticoagulants after reconstruction for chronic lower limb ischemia.

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