[Oral anticoagulant treatment: practical aspects and significance of anticoagulant clinics].
Vitamin K antagonists (VKA) decrease the synthesis of the active forms of four coagulation factors (factors II, VII, IX, X) and three inhibitors (proteins C, S, Z). There are VKA having a short half life (Sintrom, Pindione) and VKA having a long half life (Apegmone, Previscan, Coumadine). The treatment is monitored by the INR which in the majority of the indications must range between two and three. The first INR is usually performed 36 to 72 h after starting the treatment. There are a number of drug interactions. The rate of major bleedings range from 1.1 to 4.9 for 100 patient-year according to the published studies. Since around 600,000 patients are treated by VKA in our country, the absolute number of serious bleeding is high (> or = 17,000 per year). Anticoagulant clinics are structures aimed to instruct the patient and to advise the general practitioner to monitor the treatment, using computer assisted methods. It has been reported that these structures reduce the incidence of bleeding and of thrombotic events by 3 to 4 times.
Boneu
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Laboratoire d'hématologie, hôpital de Rangueil, 31054 Toulouse, France. boneu.b@chu-toulouse.fr
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D000074:Acenocoumarol / Q000008:administration & dosage; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D004347:Drug Interactions; D005194:Family Practice; D005502:Food; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D010353:Patient Education as Topic; D010630:Phenindione / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014812:Vitamin K; D010630:Phenindione; D014859:Warfarin; C017673:fluindione; D000074:Acenocoumarol