European Heart Journal Advance Access published online on April 10, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl492
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Anticoagulants in heart disease: current status and perspectives
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* Corresponding author. Institute of Cardiology, ‘G. d'Annunzio’ University—Chieti, Ospedale S. Camillo de Lellis, Via Forlanini 50, 66100 Chieti, Italy. Tel: +39 0871 415 12; fax: +39 0871 402 817/498217. E-mail address: rdecater@unich.it
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Preamble: purposes and scope of the task force |
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Drugs interfering with blood coagulation are a mainstay of cardiovascular therapy. Despite their widespread use, there are a number of unmet needs for current parenteral and oral anticoagulants in cardiovascular diseases. This therapeutic area is undergoing unprecedented changes with the clinical introduction of new drugs. This document, initiated by a committee appointed by the European Society of Cardiology (ESC) Working Group on Thrombosis, intends therefore:
- to review the current mechanism of action, pharmacological properties, indications, side effects, ongoing trials, and areas of current investigations for drugs interfering with coagulation as applied to atherothrombosis and arterial thrombo-embolism in heart disease, namely:
- coronary heart disease and percutaneous coronary interventions (PCIs);
- atrial fibrillation (AF);
- artificial heart valves;
- chronic heart failure (CHF);
- coronary heart disease and percutaneous coronary interventions (PCIs);
- to do so with a ‘pharmacologically based’ approach rather than a ‘disease-oriented’ one, complementary with what other Guidelines Groups and Task Forces have done or are in the process of doing in
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Blood coagulation |
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Haemostasis
Arterial thrombosis
Tissue factor
Tissue factor pathway inhibitor
Cellular control of coagulation
Cross-talk between coagulation and inflammation
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Epidemiology of anticoagulant therapy in heart disease |
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Coronary heart disease
Non-valvular atrial fibrillation
Prosthetic heart valves
Heart failure
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Parenteral anticoagulants: general pharmacology |
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Heparin derivatives
Unfractionated heparin
Mechanism of action
Pharmacokinetics
Dosing and monitoring
Side effects
Low molecular weight heparins
Mechanism of action
Pharmacokinetics
Dosing and monitoring
Side effects
Pentasaccharides: fondaparinux and idraparinux
Mechanism of action
Dosing
Monitoring
Side effects
Parenteral direct thrombin inhibitors
Compared pharmacological properties of unfractionated heparin, low-molecular weight heparins, pentasaccharides, and direct thrombin inhibitors
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Vitamin K antagonists: general pharmacology |
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Mechanism of action
Vitamin K anticoagulant therapy: interference with foods and drugs
Laboratory control
Dosing
Point-of-care testing and prothrombin time monitors
Self-management of oral anticoagulation
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Oral direct thrombin inhibitors: general pharmacology |
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Parenteral anticoagulants: clinical indications |
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Unfractionated heparin
Low molecular weight heparins
Non-ST-elevation acute coronary syndromes
ST-elevation acute myocardial infaction treated with fibrinolytics
Elective percutaneous coronary interventions
Percutaneous coronary interventions in the setting of acute coronary syndromes
Pentasaccharides
Fondaparinux
Idraparinux
Intravenous direct thrombin inhibitors
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Vitamin K antagonists |
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Coronary heart disease
Primary prevention
Acute coronary syndromes
Coronary bypass graft surgery
Percutaneous coronary interventions
Atrial fibrillation
Artificial heart valves
Heart failure
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Oral direct thrombin inhibitors: clinical developments |
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Oral Factor Xa inhibitors: clinical developments |
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Bleeding risk and bleeding management during anticoagulant therapy |
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General risk factors for bleeding
Unfractionated heparin and low-molecular weight heparins
Pentasaccharides
Direct thrombin inhibitors
Vitamin K antagonists
Management of bleeding complications
Unfractionated heparin and low-molecular weight heparins
Pentasaccharides
Direct thrombin inhibitors
Vitamin K antagonists
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Special situations |
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Vitamin K antagonists in pregnant patients with artificial heart valves
Renal failure and haemodialysis
Surgery, percutaneous coronary interventions, biopsies, and dental procedures
Cancer
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Anticoagulant therapy in combination with other drugs interfering with haemostasis |
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Anticoagulant therapy in combination with antiplatelet therapy
Anticoagulant therapy in combination with fibrinolytic therapy
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Current needs and future developments |
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