title: Transition to an oral anticoagulant in patients with heparin-induced thrombocytopenia.
abstract: Recommendations for transitioning from therapy with heparin or a low-molecular-weight heparin preparation to therapy with an oral anticoagulant in patients with acute venous or arterial thromboembolism have undergone several changes during the last two decades. Physicians are now comfortable with beginning treatment with an oral anticoagulant once the diagnosis is confirmed, and loading doses are no longer considered to be necessary. Exceptions to early transition may be necessary in patients with an extensive iliofemoral or axillary-subclavian vein thrombosis or pulmonary embolism where thrombolytic agents may be indicated, or in individuals who require surgery or other invasive procedures, or if there are concerns about bleeding. The avoidance of early transition to oral anticoagulants in patients with acute heparin-induced thrombocytopenia also has been advised because of the potential for further thrombotic complications, including venous limb gangrene and warfarin-induced skin necrosis.
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Ave, S-60, Cleveland, OH 44195, USA. barthoj@ccf.org
authors.forename: John R
authors.initials: JR
authors.lastname: Bartholomew
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D001777:Blood Coagulation / Q000502:physiology; D001779:Blood Coagulation Factors / Q000502:physiology; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004338:Drug Combinations; D005734:Gangrene / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D007511:Ischemia / Q000139:chemically induced; D007866:Leg / Q000098:blood supply; D009336:Necrosis / Q000139:chemically induced; D010875:Pipecolic Acids / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012867:Skin / Q000473:pathology; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy; D013927:Thrombosis / Q000139:chemically induced; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001120:Arginine; D001779:Blood Coagulation Factors; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D014859:Warfarin; C035838:danaparoid; C031942:argatroban; C083544:lepirudin