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Warfarin Therapy in Patients with Cardiac Disease: Review

Year 2008, Volume: 2 Issue: 2, 342 - 347, 27.07.2008

Abstract

Although development of treatment and definition of cardiovascular diseases and progresses in operating technique, thromboembolic complications remain a troublesome cause of mortality and morbidity. New agents are being researched, nevertheless warfarine has been used to be an effective agent, but close monotarization and cautious use is necessary due to hemorrhagic complications. Sometimes it is given at indications where it is not supposed to be used or at insufficient dosage resulting at suboptimal therapy. Warfarin inhibits hepatic synthesis of clotting factors II, VI-I, IX, and X, which depend on vitamin K for activation; it also inhibits the anticoagulant proteins C and S. Warfarin is completely absorbed when given orally and produces an anticoagulant effect within 24 hours, but the peak effect may not occur until 3 to 4 days after drug administration. A steady anticoagulation state requires 5 to 7 days because existing clotting factors must be depleted first. Warfarin accumulates in the liver until it’s broken down into inactive metabolites and excreted in urine. Patients who need rapid anticoagulation usually are started on oral warfarin and intravenous heparin concurrently, until the patient’s international normalized ratio (INR) is in the therapeutic range for at least 2 days; the heparin then can be tapered and discontinued. When a patient starts warfarin therapy, he’ll need daily monitoring of his prothrombin time (PT) and INR from after his second or third dose until he reaches the target therapeutic range and stays in that range for at least 2 consecutive days. Once a patient reaches the therapeutic range, the frequency of monitoring usually is decreased, typically to two to three times weekly for 1 or 2 weeks, then monthly. Herein we are discussing warfarine therapy in the cardiovascular diseases and predisposition to thromboembolic situations.

References

  • 1. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2005; 127(1 ):415-6
  • 2. Choonara IA, Malia RG, Haynes BP, et al. The relati- onship between inhibition of vitamin K1 2,3-epoxide reductase and reductionof clotting factor activity with warfarin. Br J Clin Pharmacol 1988;25:1-7.
  • 3. Borowski M, Furie BC, Bauminger S, et al. Prothrombin requires two sequential metal-dependent conformational transitions to bind phospolipids: conformation-spe- cific antibodies directed against the phospholipid-binding site on prothrombin. J biol chem 1986;261:14969-75.
  • 4. O'reilly RA, Trager WF. Stereoselective interaction of phenylbutazone with 13C/12C labelled racemates of warfarin in man (abstr). Fed Proc 1978;37:545.
  • 5. Toon s, Low LK, Gibaldi, M, et al. The warfarin sulfinpyrazone interaction: stereochemical considerations. Clin Pharmacol Ther 1986;39:15-24.
  • 6. O’reilly RA. The stereoselective interaction of warfarin and metronidazole in man. N Eng J Med 1976;295:354-7.
  • 7. O’Reilly RA. Stereoselective interaction of warfarin and trimethoprim-sulfamethoxazole with seperated enentio-morphs of racemic warfarin in man. N Eng J Med 1980;302:33-5.
  • 8. O’Reilly RA, Trager WF, Rettie AE, et al. Interaction of amiodarone with racemic warfarin and its separated enantiomorphs in humans. Clin Pharmacol Ther 1987;42:290-4.
  • 9. O’Reilly RA. Lack of effect of fortified wine ingested during fasting and anticoagulant therapy. Arch Intern med 1981;141:458-9.
  • 10. Bechtold H, Andrassy K, Jahnchen E, et al. Evidence for impaired hepatic vitamin K1 metabolism in patient treated N-methyl-thiotetrazole cephalosporins. Thromb Haemost 1984; 51:358-61.
  • 11. Owens JC, Neely WB, Owen WR. Effect of sodium dextrothyroxine in patients receiving anticoagulants. N Eng J Med 1962;266:76-9
  • 12. Rothschild BM. Hematologic perturbations associated with salicylate. Clin Pharmacol Ther 1979;26:145-52.
  • 13. Hylek EM, Heiman H, Skates SJ, et al. Acetaminofen and other risk factors for excessive warfarin anticoagü-lation. JAMA 1998;279:657-62.
  • 14. Bell WR. Acetaminophen and warfarin: undesirable synergy. JAMA 1998;279:702-3.
  • 15. Schulman S, Henriksson K. Interaction of ibuprofen and warfarin on primary haemostasis. Br J Rheumatol 1989;28:46-9.
  • 16. Brown CH II, Natelson EA, Bradshaw W, et al. The hemostatic defect produced by carbenicillin. N Eng J Med 1974;291:265-70.
  • 17. Weibert RT, Lorentz SM, Townsend RJ, et al. Effect of erythromicin in patients receiving long-term warfarin therapy. Clin Pharm 1989;8:210-24.
  • 18. Lorentz SM, Weibert RT. Potentiation of warfarin anticoagulation by topical testosterone treatment. Clin Pharm 1985;4:332-4.
  • 19. Mannuci PM. Gnetic control of anticoagülation. Lancet 1999;353:688-9.
  • 20. James AH, Britt RP, Raskino CL, et al. Factors affecting the maintenance dose of warfarin. J Clin Pathol 1992;45:704-6.
  • 21. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest 2001 ;119 Suppl: 22S-38S.
  • 22. Kearon C, Hirh J. Management of anticoagulation before and after elective surgery. N Eng J Med 1997;336-1506-11.
  • 23. Sindet-Pedersen S, Ramstrom G, Bemvil S, et al. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N engJMed 1989;320:840-3.
  • 24. Souto JC, Oliver A, ZuaZu-Jausoro I, et al. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg 1996;54:27-32.
  • 25. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulationduring pregnancy. J Pediatr 1975;86:459-62.
  • 26. The Medical Research Concil’s General Practice Research Framework. Thrombosis prevention Trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention is ischaemic heart disease in men at increased risk. Lancet 1998;351:233-41.
  • 27. Kearon C, Gent M, Hirsh J, et al. A comparison of thre-e months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Eng J Med 1990;340:901-7.
  • 28. Hull R, Hirsh J, Jay R, et al. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Eng J Med 1982;307:1676-81.
  • 29. Cairns JA, Hirsh J, Lewis HD, et al. Antithrombotic agents in coronary artery disease. Chest 1992;102 suppl:456s-81s.
  • 30. Goldberg RJ, Gore JM, Dalen JE, et al. Long-term anticoagulant therapy after acute myocardial infarction. Am Heart J 1985;109: 616-22.
  • 31. Leizorovicz A, Boissel JP. Oral anticoagulant in patients surviving myocardial infarction: a new approach to old data. Eur J Clin Pharmacol 1983;24:333-6.
  • 32. Smith P, Amesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Eng J Med 1990;323:147-52.
  • 33. ASPECT Research Group. Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Lancet 1994;343:499-503.
  • 34 van Es RF. Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis-2. Abstract presented at the 22nd meeting of the European Society of Cardiology, Amsterdam, 2000.
  • 35. Brower MA. Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2. Abstract presented at the 22nd meeting of the European Society of Cardiology, Amsterdam, 2000.
  • 36. Hürlen M, Smith P, Abdelnoor M, et al. Warfarin aspirin Reinfarction Rtudy II. Effects of warfarin, aspirin and the two combined, on mortality and thromboembolic morbidity after myocardial infarction. Abstract presented at the 23rd meeting of the European Society of Cardiology, Stockholm, 2001.
  • 37. Coumadin Aspirin Reinfarction Study (CARS) Investigators. Randomised double-blind trial of fixed low-dose warfarin with aspirin after myocardial infarction. Lancet 1997;350:389-96.
  • 38. Fiore LD, Ezekowitz MD, Brophy Mt, et al. Department of Veterans Affairs Cooperative Program Clinical Trial comparing combined warfarin and aspirin alone in survivors of acute myocardial infarction: primary results of the Champ study. Circulation 2002;105:557-63.
  • 39. Cohen M, Adams PC, Parry G, et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users: primary end point analysis from the ATACS trial. Circulation 1994;89:81-8.
  • 40. Anand SS, Yusuf S, Pogue J, et al. Long-term oral anticoagulant therapy in patients with unstable angina or suspected non-Q-wave myocardial infarction: Organization to Assess Strategies for Ischemic Syndromes (OASIS) pilot study results. Circulation 1998;98:1064-70.
  • 41. Mok CK, Boey J, Wang R, et al. Warfarin versus dipyri-damole-aspirin and petoxifylline-aspirin fort the prevention of prosthetic heart valve thromboembolism: a prospective clinical trial. Circulation 1985;72:1059-63.
  • 42. Turpie AGG, Gunstensen J, Hirsh J, et al. Randomized comparison two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet 1988;1:1242-5.
  • 43. Saour JN, Sieck JO, Mamo LAR, et al. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Eng J Med 1990;322:428-32.
  • 44. Turpie AG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Eng J Med 1993;329-524-9.
  • 45. Cannegieter SC, Rosendaal FR, Wintzen AR, et al. Optimal oral anticoagulant therapy in patients with mechanical heart valve prostheses: the Leiden artificial valve and anticoagulation study. N Eng J Med 1995;333:11-7.
  • 46. Gohlke-Barwolf, Acar J, Oakley C, et al. Guidelines for prevention of thromboembolic events in valvular heart disease: Study Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 1995;16:1320-30.
  • 47. Stein PD, Alpert JS, Dalen JE, et al. Antithrombotic therapy in patients with mechanical and biological heart valves. Chest 1998:114 Suppl:602S-10S.
  • 48. ACC/AHA guidelines fort the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practise Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998;32:1846-588.
  • 49. Bayliss A, Faber P, Dunning J, Ronald AWhat is the optimal level of anticoagulation in adult patients receiving warfarin following implantation of a mechanical prosthetic mitral valve? Interact Cardiovasc Thorac Surg. 2007;6(3): 390-6.
  • 50. Eitz T, Schenk S, Fritzsche D, Bairaktaris A, Wagner O, Koertke H, Koerfer R. International normalized ratio selfmanagement lowers the risk of thromboembolic events after prosthetic heart valve replacement. Ann Thorac Surg. 2008 Mar;85(3):949-54
  • 51. Breckenridge A. Oral anticoagulant drugs: pharmacokinetic aspects. Semin Hamatol 1978; 15.19-26.
  • 52. O’Reilly RA. Vitamin K and other oral anticoagulant drugs. Annu Rev Med 1976;27:245-61.
  • 53. Bovil EG, Lawson J, Sadowski J, et al. Mechanisms of vitamin K metabolism and vitamin K-dependent hemostasis: implications forwarfarin therapy. In: Ezekowitz MD, editors. The Heart as a Source of Systemic Embolisation. New York, NY: Marcel Dekker; 1992.
  • 54. Foster et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines J Am Coll Cardiol. 2006;48(4):854-906.
  • 55. Mas JL, Arquizan C, Lamy C, Zuber M, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Eng J Med 2001;345:1740-6.
  • 56. Sherman DG, Dyken ML, Gent M, et al. Antithrombotic therapy for cerebrovascular disorders: an update. Chest 1995;108:444S-56S.
  • 57. Mohr JP, Thompson JL, Lazar RM, et al. A comparison of warfarin and aspirin fort he prevetionpnrnotl of recurrent ischemic stroke. N Engl J Med 2001 ;345:1444-51.
  • 58. Fuster V, Gersh BJ, Giuliani ER, et al. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 1981;47:525-31.
  • 59. Pullicino PM, Halperin JL, Thompson JL. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000;54:288-94.

Kardiyak Hastalarda Warfarin Tedavisi

Year 2008, Volume: 2 Issue: 2, 342 - 347, 27.07.2008

Abstract

kardiyovasküler hastalıkların tanı ve tedavisindeki gelişmeler ve operasyon tekniklerindeki ilerlemelere rağmen tromboembolik komplikasyonlar mortalite ve morbiditenin en korkulan sebebi olarak kalmıştır. Antikoagülan tedavide yeni araştırılan ajanlar olmakla birlikte halen warfarin elde bulunan en etkili ajan olarak kullanılmaktadır. Ancak kanama komplikasyonlan nedeniyle yakın monitörizasyonu ve dikkatli kullanılması gerekmektedir. Bazen gereksiz endikasyonlarda kullanıldığı gibi genellikle yetersiz dozda kullanılarak yetersiz antikoagulasyon sağlanmakta ve optimal tedavi hedeflerine ulaşılamamaktadır. Warfarin, aktivasyonu için K vitaminine bağımlı olan pıhtılaşma faktörleri II, VII, IX ve X un karaciğerde sentezini inhibe eder. Warfarin ayni zamanda anti-koagulan protein C ve S’yi de inhibe eder. Warfarin ağızdan verildiğinde tamamen emilir ve 24 saat içinde antikoagülan etkisi baslar. Fakat pik etki 3-4 gün sonra oluşur. Tam bir antikoagülan etki için 5-7 gün geçmesi gerekir. Çünkü var olan pıhtılaşma faktörlerinin tükenmesi gereklidir. Warfarin inaktif metabolitlerine dönüşünceye kadar karaciğerde birikir ve idrarla atılır. Hızlı antikoagulasyon gerektiren hastalar oral antikoagülan ile birlikte intravenöz heparin beraber başlanır ve INR veya protrombin zamanının hedef değerine ulaşıncaya kadar en azından 2 gün birlikte verilir ve sonrasında heparin dozu azaltılarak kesilir. Hastaya warfarin başlandığında hedef değere ulaşıncaya kadar günlük olarak 2-3 gün takip edilir. Sonrasında 1-2 hafta, haftada 2-3 kez daha sonra aylık takip edilir. Burada kalp hastalıklarından özellikle atriyal fibrilasyon, mekanik kalp kapağı, akut miyokard in-farktüsü ve ilgili tromboemboliye yatkınlık durumlarında warfarin tedavisini tartıştık.

References

  • 1. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2005; 127(1 ):415-6
  • 2. Choonara IA, Malia RG, Haynes BP, et al. The relati- onship between inhibition of vitamin K1 2,3-epoxide reductase and reductionof clotting factor activity with warfarin. Br J Clin Pharmacol 1988;25:1-7.
  • 3. Borowski M, Furie BC, Bauminger S, et al. Prothrombin requires two sequential metal-dependent conformational transitions to bind phospolipids: conformation-spe- cific antibodies directed against the phospholipid-binding site on prothrombin. J biol chem 1986;261:14969-75.
  • 4. O'reilly RA, Trager WF. Stereoselective interaction of phenylbutazone with 13C/12C labelled racemates of warfarin in man (abstr). Fed Proc 1978;37:545.
  • 5. Toon s, Low LK, Gibaldi, M, et al. The warfarin sulfinpyrazone interaction: stereochemical considerations. Clin Pharmacol Ther 1986;39:15-24.
  • 6. O’reilly RA. The stereoselective interaction of warfarin and metronidazole in man. N Eng J Med 1976;295:354-7.
  • 7. O’Reilly RA. Stereoselective interaction of warfarin and trimethoprim-sulfamethoxazole with seperated enentio-morphs of racemic warfarin in man. N Eng J Med 1980;302:33-5.
  • 8. O’Reilly RA, Trager WF, Rettie AE, et al. Interaction of amiodarone with racemic warfarin and its separated enantiomorphs in humans. Clin Pharmacol Ther 1987;42:290-4.
  • 9. O’Reilly RA. Lack of effect of fortified wine ingested during fasting and anticoagulant therapy. Arch Intern med 1981;141:458-9.
  • 10. Bechtold H, Andrassy K, Jahnchen E, et al. Evidence for impaired hepatic vitamin K1 metabolism in patient treated N-methyl-thiotetrazole cephalosporins. Thromb Haemost 1984; 51:358-61.
  • 11. Owens JC, Neely WB, Owen WR. Effect of sodium dextrothyroxine in patients receiving anticoagulants. N Eng J Med 1962;266:76-9
  • 12. Rothschild BM. Hematologic perturbations associated with salicylate. Clin Pharmacol Ther 1979;26:145-52.
  • 13. Hylek EM, Heiman H, Skates SJ, et al. Acetaminofen and other risk factors for excessive warfarin anticoagü-lation. JAMA 1998;279:657-62.
  • 14. Bell WR. Acetaminophen and warfarin: undesirable synergy. JAMA 1998;279:702-3.
  • 15. Schulman S, Henriksson K. Interaction of ibuprofen and warfarin on primary haemostasis. Br J Rheumatol 1989;28:46-9.
  • 16. Brown CH II, Natelson EA, Bradshaw W, et al. The hemostatic defect produced by carbenicillin. N Eng J Med 1974;291:265-70.
  • 17. Weibert RT, Lorentz SM, Townsend RJ, et al. Effect of erythromicin in patients receiving long-term warfarin therapy. Clin Pharm 1989;8:210-24.
  • 18. Lorentz SM, Weibert RT. Potentiation of warfarin anticoagulation by topical testosterone treatment. Clin Pharm 1985;4:332-4.
  • 19. Mannuci PM. Gnetic control of anticoagülation. Lancet 1999;353:688-9.
  • 20. James AH, Britt RP, Raskino CL, et al. Factors affecting the maintenance dose of warfarin. J Clin Pathol 1992;45:704-6.
  • 21. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest 2001 ;119 Suppl: 22S-38S.
  • 22. Kearon C, Hirh J. Management of anticoagulation before and after elective surgery. N Eng J Med 1997;336-1506-11.
  • 23. Sindet-Pedersen S, Ramstrom G, Bemvil S, et al. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N engJMed 1989;320:840-3.
  • 24. Souto JC, Oliver A, ZuaZu-Jausoro I, et al. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg 1996;54:27-32.
  • 25. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulationduring pregnancy. J Pediatr 1975;86:459-62.
  • 26. The Medical Research Concil’s General Practice Research Framework. Thrombosis prevention Trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention is ischaemic heart disease in men at increased risk. Lancet 1998;351:233-41.
  • 27. Kearon C, Gent M, Hirsh J, et al. A comparison of thre-e months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Eng J Med 1990;340:901-7.
  • 28. Hull R, Hirsh J, Jay R, et al. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Eng J Med 1982;307:1676-81.
  • 29. Cairns JA, Hirsh J, Lewis HD, et al. Antithrombotic agents in coronary artery disease. Chest 1992;102 suppl:456s-81s.
  • 30. Goldberg RJ, Gore JM, Dalen JE, et al. Long-term anticoagulant therapy after acute myocardial infarction. Am Heart J 1985;109: 616-22.
  • 31. Leizorovicz A, Boissel JP. Oral anticoagulant in patients surviving myocardial infarction: a new approach to old data. Eur J Clin Pharmacol 1983;24:333-6.
  • 32. Smith P, Amesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Eng J Med 1990;323:147-52.
  • 33. ASPECT Research Group. Effect of long-term oral anticoagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Lancet 1994;343:499-503.
  • 34 van Es RF. Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis-2. Abstract presented at the 22nd meeting of the European Society of Cardiology, Amsterdam, 2000.
  • 35. Brower MA. Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis-2. Abstract presented at the 22nd meeting of the European Society of Cardiology, Amsterdam, 2000.
  • 36. Hürlen M, Smith P, Abdelnoor M, et al. Warfarin aspirin Reinfarction Rtudy II. Effects of warfarin, aspirin and the two combined, on mortality and thromboembolic morbidity after myocardial infarction. Abstract presented at the 23rd meeting of the European Society of Cardiology, Stockholm, 2001.
  • 37. Coumadin Aspirin Reinfarction Study (CARS) Investigators. Randomised double-blind trial of fixed low-dose warfarin with aspirin after myocardial infarction. Lancet 1997;350:389-96.
  • 38. Fiore LD, Ezekowitz MD, Brophy Mt, et al. Department of Veterans Affairs Cooperative Program Clinical Trial comparing combined warfarin and aspirin alone in survivors of acute myocardial infarction: primary results of the Champ study. Circulation 2002;105:557-63.
  • 39. Cohen M, Adams PC, Parry G, et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users: primary end point analysis from the ATACS trial. Circulation 1994;89:81-8.
  • 40. Anand SS, Yusuf S, Pogue J, et al. Long-term oral anticoagulant therapy in patients with unstable angina or suspected non-Q-wave myocardial infarction: Organization to Assess Strategies for Ischemic Syndromes (OASIS) pilot study results. Circulation 1998;98:1064-70.
  • 41. Mok CK, Boey J, Wang R, et al. Warfarin versus dipyri-damole-aspirin and petoxifylline-aspirin fort the prevention of prosthetic heart valve thromboembolism: a prospective clinical trial. Circulation 1985;72:1059-63.
  • 42. Turpie AGG, Gunstensen J, Hirsh J, et al. Randomized comparison two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet 1988;1:1242-5.
  • 43. Saour JN, Sieck JO, Mamo LAR, et al. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Eng J Med 1990;322:428-32.
  • 44. Turpie AG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Eng J Med 1993;329-524-9.
  • 45. Cannegieter SC, Rosendaal FR, Wintzen AR, et al. Optimal oral anticoagulant therapy in patients with mechanical heart valve prostheses: the Leiden artificial valve and anticoagulation study. N Eng J Med 1995;333:11-7.
  • 46. Gohlke-Barwolf, Acar J, Oakley C, et al. Guidelines for prevention of thromboembolic events in valvular heart disease: Study Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 1995;16:1320-30.
  • 47. Stein PD, Alpert JS, Dalen JE, et al. Antithrombotic therapy in patients with mechanical and biological heart valves. Chest 1998:114 Suppl:602S-10S.
  • 48. ACC/AHA guidelines fort the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practise Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998;32:1846-588.
  • 49. Bayliss A, Faber P, Dunning J, Ronald AWhat is the optimal level of anticoagulation in adult patients receiving warfarin following implantation of a mechanical prosthetic mitral valve? Interact Cardiovasc Thorac Surg. 2007;6(3): 390-6.
  • 50. Eitz T, Schenk S, Fritzsche D, Bairaktaris A, Wagner O, Koertke H, Koerfer R. International normalized ratio selfmanagement lowers the risk of thromboembolic events after prosthetic heart valve replacement. Ann Thorac Surg. 2008 Mar;85(3):949-54
  • 51. Breckenridge A. Oral anticoagulant drugs: pharmacokinetic aspects. Semin Hamatol 1978; 15.19-26.
  • 52. O’Reilly RA. Vitamin K and other oral anticoagulant drugs. Annu Rev Med 1976;27:245-61.
  • 53. Bovil EG, Lawson J, Sadowski J, et al. Mechanisms of vitamin K metabolism and vitamin K-dependent hemostasis: implications forwarfarin therapy. In: Ezekowitz MD, editors. The Heart as a Source of Systemic Embolisation. New York, NY: Marcel Dekker; 1992.
  • 54. Foster et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines J Am Coll Cardiol. 2006;48(4):854-906.
  • 55. Mas JL, Arquizan C, Lamy C, Zuber M, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Eng J Med 2001;345:1740-6.
  • 56. Sherman DG, Dyken ML, Gent M, et al. Antithrombotic therapy for cerebrovascular disorders: an update. Chest 1995;108:444S-56S.
  • 57. Mohr JP, Thompson JL, Lazar RM, et al. A comparison of warfarin and aspirin fort he prevetionpnrnotl of recurrent ischemic stroke. N Engl J Med 2001 ;345:1444-51.
  • 58. Fuster V, Gersh BJ, Giuliani ER, et al. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 1981;47:525-31.
  • 59. Pullicino PM, Halperin JL, Thompson JL. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000;54:288-94.
There are 59 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Reviews
Authors

Murat Akçay

Publication Date July 27, 2008
Published in Issue Year 2008 Volume: 2 Issue: 2

Cite

APA Akçay, M. (2008). Kardiyak Hastalarda Warfarin Tedavisi. Turkish Medical Journal, 2(2), 342-347.

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