Current Concepts in Anticoagulant Therapy

摘要: An understanding of the international normalized ratio (INR)—which was developed to standardize reporting prothrombin time (PT) and provide consistent regulation anticoagulation—is important. The recommended therapeutic range for INR (which is calculated from patient's PT, a mean control sensitivity index) oral anticoagulant treatment most conditions 2.0 3.0. In patients with mechanical cardiac valves, should be at least 2.5 3.5. A common cause progression venous thromboembolic disease failure inadequate heparinization during first day treatment. Therefore, an intravenous bolus 5,000 10,000 U heparin administered before maintenance infusion initiated. Also treatment, warfarin therapy can implemented. Overlap 4 or 5 days recommended. Low-molecular-weight heparins, new class anticoagulants, have been shown more effective than standard in preventing thrombosis orthopedic surgical patients, but higher cost. Patients valves who are receiving scheduled noncardiac operations must risk-to-benefit assessment need continuous anticoagulation performed preoperatively. Many these safely discontinue several as outpatients procedure. Preoperative withdrawal hospital only those high risk systemic embolization (with mitral valve prosthesis, cardiomyopathy, previous thromboembolism). concurrent use certain drugs presence comorbid predispose hemorrhagic complications therapy. Discontinuation administration vitamin K, replacement K-dependent coagulation factors transfusion fresh-frozen plasma will reverse effects warfarin.