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CC BY-NC-ND 4.0 · Thromb Haemost 2024; 124(08): 803-809
DOI: 10.1055/s-0044-1782688
Stroke, Systemic or Venous Thromboembolism

Practical Suggestions for an Optimal Management of Vitamin K Antagonists: Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) Position Paper

Silvia Galliazzo
1   Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Sant'Anna Hospital, ASST Lariana, Como, Italy
,
Paolo Bucciarelli
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
,
Doris Barcellona 
3   Thrombosis and Haemostasis Unit, University of Cagliari, Cagliari, Italy
,
Antonio Ciampa
4   Haemostasis Center, AORN S.G. Moscati, Avellino, Italy
,
Elvira Grandone
5   Thrombosis and Haemostasis Unit, IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
,
Giuseppe Malcangi
6   Haemophilia and Thrombosis Center, AOU Policlinico, Bari, Italy
,
Giuseppe Rescigno
7   Haemostasis and Thrombosis Center, DEA P.O. “Umberto I,” Nocera Inferiore, Salerno, Italy
,
Alessandro Squizzato 
1   Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Sant'Anna Hospital, ASST Lariana, Como, Italy
,
Vincenzo Toschi
8   Department of Haematology and Blood Transfusion and Thrombosis Center, Santi Paolo e Carlo Hospital, Milan, Italy
,
Sophie Testa
9   Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
,
Daniela Poli
10   Thrombosis Center, 'Careggi' Hospital, Florence, Italy
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Abstract

In the era of direct oral anticoagulants, vitamin K antagonists retain a clinically relevant role in thrombotic disorders. In Italy, approximately 20% of the patients on anticoagulant therapies receives a VKA, in most cases warfarin. The optimal management of this drug is challenging and cannot disregard its intricate and unpredictable pharmacokinetic properties and patient's thrombotic and bleeding risk. Several clinical issues encountered during warfarin treatment are still unanswered and are tentatively addressed by physicians. In this regard, the Italian Federation of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic therapies (FCSA) provides some experience-based good clinical practice's suggestions on the following topics: (1) how to start the anticoagulant treatment with warfarin and warfarin induction regimen; (2) how to manage a subtherapeutic INR value; (3) how to manage a supratherapeutic INR value in asymptomatic patients; and (4) how to manage the association of warfarin with interfering drugs.

Keywords

anticoagulant - warfarin - vitamin K antagonists

*LMWH at low dose means a dose of prophylaxis; LMWH at intermediate dose means 50% of the LMWH therapeutic dose.




Publikationsverlauf

Eingereicht: 18. August 2023

Angenommen: 10. Januar 2024

Artikel online veröffentlicht:
16. April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 ClinCalc DrugStats Database [Internet]. Accessed March 6, 2024 at: https://clincalc.com/DrugStats/
    PubMed
  • 2 Budnitz DS, Shehab N, Lovegrove MC, Geller AI, Lind JN, Pollock DA. US emergency department visits attributed to medication harms, 2017–2019. JAMA 2021; 326 (13) 1299-1309
    CrossrefPubMedSuche in Google Scholar
  • 3 Palareti G, Leali N, Coccheri S. et al; Italian Study on Complications of Oral Anticoagulant Therapy. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 1996; 348 (9025) 423-428
    CrossrefPubMedSuche in Google Scholar
  • 4 Entezari-Maleki T, Dousti S, Hamishehkar H, Gholami K. A systematic review on comparing 2 common models for management of warfarin therapy; pharmacist-led service versus usual medical care. J Clin Pharmacol 2016; 56 (01) 24-38
    CrossrefPubMedSuche in Google Scholar
  • 5 Holbrook A, Schulman S, Witt DM. et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 suppl): e152S-e184S
    CrossrefPubMedSuche in Google Scholar
  • 6 Palareti G, Legnani C, Guazzaloca G. et al; ad hoc Study Group of the Italian Federation of Anticoagulation Clinics.. Risks factors for highly unstable response to oral anticoagulation: a case-control study. Br J Haematol 2005; 129 (01) 72-78
    CrossrefPubMedSuche in Google Scholar
  • 7 Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest; 2012. 141. (2 suppl): e44S-e88S
    Suche in Google Scholar
  • 8 Monagle P, Chan AKC, Goldenberg NA. et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 suppl): e737S-e801S
    CrossrefPubMedSuche in Google Scholar
  • 9 Garcia D, Regan S, Crowther M, Hughes RA, Hylek EM. Warfarin maintenance dosing patterns in clinical practice: implications for safer anticoagulation in the elderly population. Chest 2005; 127 (06) 2049-2056
    CrossrefPubMedSuche in Google Scholar
  • 10 van Leeuwen Y, Rosendaal FR, van der Meer FJM. The relationship between maintenance dosages of three vitamin K antagonists: acenocoumarol, warfarin and phenprocoumon. Thromb Res 2008; 123 (02) 225-230
    CrossrefPubMedSuche in Google Scholar
  • 11 Garcia D, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 suppl): e24S-e43S
    CrossrefPubMedSuche in Google Scholar
  • 12 Spyropoulos AC, Brohi K, Caprini J. et al; SSC Subcommittee on Perioperative and Critical Care Thrombosis and Haemostasis of the International Society on Thrombosis and Haemostasis. Scientific and Standardization Committee Communication: guidance document on the periprocedural management of patients on chronic oral anticoagulant therapy: recommendations for standardized reporting of procedural/surgical bleed risk and patient-specific thromboembolic risk. J Thromb Haemost 2019; 17 (11) 1966-1972
    PubMedSuche in Google Scholar
  • 13 Holbrook AM, Pereira JA, Labiris R. et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 2005; 165 (10) 1095-1106
    CrossrefPubMedSuche in Google Scholar
  • 14 Wang M, Zeraatkar D, Obeda M. et al. Drug-drug interactions with warfarin: a systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87 (11) 4051-4100
    CrossrefPubMedSuche in Google Scholar