[Prescription and follow-up of antithrombotic treatment with vitamin K antagonists].

Abstract

The indications for antithrombotic treatment with vitamin K antagonists are now relatively precise, but management of this treatment is often difficult in clinical practice and be set by problems such as unstable hypocoagulability, an increased bleeding risk, interactions with other therapies and pathologies, and high-level vitamin K intake in the diet. Rigorous and accurate information of the patient and family, along with regular and frequent control of the international normalized ratio (INR), are essential for the safety and efficacy of this treatment. Some physicians cite an excessive bleeding risk as one reason for withholding oral anticoagulation therapy from older patients with atrial fibrillation. Indeed, with the increasing aging of the population, and poor therapeutic observance, there is an increased risk of hemorragic adverse effects. However, vitamin K antagonists are associated with a significant reduction in embolic events, and recent guidelines recommend their prescription for elderly patients with atrial fibrillation. Their impact on the risk of thromboembolic events is well documented, with better results than those obtained with new oral anticoagulants. Education of the patient and family, and close cooperation between the patient, family, physician and entire medical team, are essential for the safety and efficacy of this treatment.

• Authors: Jean-Paul Bounhoure
• Journal: Bulletin de l'Academie nationale de medecine (Bull Acad Natl Med) Vol. 197 Issue 8 Pg. 1561-70; discussion 1570-1 (Nov 2013) ISSN: 0001-4079 [Print] Netherlands
• Vernacular Title: Prescription et suivi d'un traitement anticoagulant par les antivitamines K.
• PMID: 26021177 (Publication Type: English Abstract, Journal Article)

Chemical References

• 4-Hydroxycoumarins
• Anticoagulants
• Indenes
• antivitamins K
• Vitamin K

Topics

• 4-Hydroxycoumarins (therapeutic use)
• Anticoagulants (therapeutic use)
• Drug Monitoring (standards)
• Drug Prescriptions
• Humans
• Indenes (therapeutic use)
• Monitoring, Physiologic (methods)
• Practice Patterns, Physicians' (standards)
• Thrombosis (drug therapy)
• Treatment Outcome
• Vitamin K (antagonists & inhibitors, therapeutic use)