Practical management of coagulopathy associated with warfarin

@article{Garcia2010PracticalMO,
  title={Practical management of coagulopathy associated with warfarin},
  author={David A. Garcia and Mark Andrew Crowther and Walter Ageno},
  journal={BMJ : British Medical Journal},
  year={2010},
  volume={340}
}
When choosing a management strategy for a patient who is being treated with a vitamin K antagonist and presents with an INR outside the therapeutic range, consider the risk of both bleeding and thrombosis 
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Despite development of new oral anticoagulant therapy compounds, warfarin will probably retain a prominent role in thromboembolism management for several years to come.
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An overview of the most commonly used vitamin K antagonists is provided and the importance of assessing quality of anticoagulation with respect to clinical outcomes is discussed, drawing on evidence where applicable and expert opinion where evidence is limited.
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Anti-coagulation Drug Warfarin Contributes to Severe Adverse Outcomes in Prolonged Unsupervised Use: A Double-edged Sword
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A 58-year-old Caucasian male presented with non-traumatic acute quadriplegia with cord compression starting at the 3rd cervical (C3) level and continuing throughout the entire spinal cord and it became evident that his patient had been on a prolonged and unsupervised warfarin (Coumadin) regimen for congestive heart failure without primary care follow-up or routine laboratory testing.
The misconceptions about warfarin.
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The role of anti-platelet agents, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors in worsening warfarin-related bleeding needs emphasis.
Diagnosis and management of the antiphospholipid syndrome
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This complicated and intriguing syndrome is introduced, and basic guiding principles for the recognition, diagnosis, and management of affected patients are provided.
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In this chapter, the models of coagulation are described as well as the different anticoagulants used in clinical practice with their pharmacological properties.
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The in vitro effect of PCC dosing on international normalised ratio (INR) and factor activity suggests that INR correction alone may not accurately reflect factor activity, and lends support for weight-based dosing.
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TLDR
In patients receiving warfarin who have asymptomatic excessive prolongations in their INR results, 1 mg of oral vitamin K reliably reduces the INR to the therapeutic range within 24 h, suggesting this therapy is more convenient, less expensive, and might be safer than parenteral vitamin K.
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