title: Effect of diseases on response to vitamin K antagonists.
abstract: BACKGROUND
  The purpose of this review article is to summarize the literature on diseases that are documented to have an effect on response to warfarin and other VKAs.
  
  
  METHODS
  We searched the English literature from 1946 to September 2015 via PubMed, EMBASE, and Scopus for the effect of diseases on response vitamin K antagonists including warfarin, acenocoumarol, phenprocoumon, and fluindione.
  
  
  CONCLUSIONS
  Among many factors modifying response to VKAs, several disease states are clinically relevant. Liver disease, hyperthyroidism, and CKD are well documented to increase response to VKAs. Decompensated heart failure, fever, and diarrhea may also elevate response to VKAs, but more study is needed. Hypothyroidism is associated with decreased effect of VKAs, and obese patients will likely require higher initial doses of VKAs.
  
  
  CONCLUSIONS
  In order to minimize risks with VKAs while ensuring efficacy, clinicians must be aware of the effect of disease states when prescribing these oral anticoagulants.
authors.affiliation: a Methodist University Hospital, Clinical Pharmacist , Memphis , TN , USA ;
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Self
authors.affiliation: b Methodist University Hospital , Memphis , TN , USA ;
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Owens
authors.affiliation: a Methodist University Hospital, Clinical Pharmacist , Memphis , TN , USA ;
authors.forename: Sami A
authors.initials: SA
authors.lastname: Sakaan
authors.affiliation: c Veterans Affairs Medical Center , Nashville , TN , USA ;
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Wallace
authors.affiliation: d Methodist University Hospital, Methodist Inpatient Physicians , Memphis , TN , USA .
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Sands
authors.affiliation: e Memphis , Memphis , TN , USA .
authors.forename: Amanda
authors.initials: A
authors.lastname: Howard-Thompson
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D003967:Diarrhea / Q000150:complications / Q000188:drug therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy; D009765:Obesity / Q000150:complications / Q000188:drug therapy; D010630:Phenindione / Q000031:analogs & derivatives / Q000627:therapeutic use; D010644:Phenprocoumon / Q000627:therapeutic use; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014812:Vitamin K; D010630:Phenindione; D014859:Warfarin; C017673:fluindione; D000074:Acenocoumarol; D010644:Phenprocoumon
keywords: Disease interaction; heart failure; liver disease; obesity; thyroid disorder; vitamin K antagonists; warfarin