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Establishing an Optimal Therapeutic Range for Coumarins

Establishing an Optimal Therapeutic Range for Coumarins EDITORIAL Establishing an Optimal Therapeutic Range for Coumarins Filling in the Gaps OUMARINS HAVE BEEN THE MAINSTAY OF in which the outcomes are compared before and after chang- oral anticoagulant therapy for more than ing the target anticoagulant intensity in the same orga- 50 years. Their effectiveness has been es- nized anticoagulant clinic (ie, with a historical control tablished by well-designed clinical trials group). All of these designs have limitations, but the ran- C for primary and secondary prevention of domized trial comparing 2 target INR ranges provides the venous thromboembolism, for prevention of systemic em- most reliable results because, if appropriately designed, it bolism in patients with prosthetic heart valves or atrial is free of bias. 11-14 fibrillation, for primary prevention of acute myocardial Four randomized studies have compared a mod- infarction in high-risk men, and for prevention of stroke, erate intensity with higher intensity adjusted-dose oral recurrent infarction, or death in patients with acute myo- anticoagulation, and all reported that the moderate in- cardial infarction. The effectiveness and safety of oral tensity reduced the risk of clinically significant bleed- anticoagulants are less clear in patients with cerebrovas- ing, without reducing efficacy. In 2 of these studies, one http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Establishing an Optimal Therapeutic Range for Coumarins

O'Donnell, Martin; Hirsh, Jack
JAMA Internal Medicine , Volume 164 (6) – Mar 22, 2004
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References (39)

Publisher
American Medical Association
Copyright
Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/archinte.164.6.588
pmid
15037485
Publisher site
See Article on Publisher Site

Abstract

EDITORIAL Establishing an Optimal Therapeutic Range for Coumarins Filling in the Gaps OUMARINS HAVE BEEN THE MAINSTAY OF in which the outcomes are compared before and after chang- oral anticoagulant therapy for more than ing the target anticoagulant intensity in the same orga- 50 years. Their effectiveness has been es- nized anticoagulant clinic (ie, with a historical control tablished by well-designed clinical trials group). All of these designs have limitations, but the ran- C for primary and secondary prevention of domized trial comparing 2 target INR ranges provides the venous thromboembolism, for prevention of systemic em- most reliable results because, if appropriately designed, it bolism in patients with prosthetic heart valves or atrial is free of bias. 11-14 fibrillation, for primary prevention of acute myocardial Four randomized studies have compared a mod- infarction in high-risk men, and for prevention of stroke, erate intensity with higher intensity adjusted-dose oral recurrent infarction, or death in patients with acute myo- anticoagulation, and all reported that the moderate in- cardial infarction. The effectiveness and safety of oral tensity reduced the risk of clinically significant bleed- anticoagulants are less clear in patients with cerebrovas- ing, without reducing efficacy. In 2 of these studies, one

Journal

JAMA Internal Medicine – American Medical Association

Published: Mar 22, 2004

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