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Chest. 2012 Feb;141(2 Suppl):e152S-e184S. doi: 10.1378/chest.11-2295.

Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Author information

1
Division of Clinical Pharmacology and Therapeutics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Electronic address: holbrook@mcmaster.ca.
2
Department of Medicine, McMaster University, Hamilton, ON, Canada.
3
Department of Pharmacy, Kaiser Permanente Colorado, Denver, CO.
4
Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
5
Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA.
6
Department of Medicine, University of Western Ontario, London, ON, Canada.
7
Department for Coagulation Disorders, University of Lund, University Hospital, Malmö, Sweden.
8
Department of Pharmacy, University of Washington, Seattle, WA.
9
Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices.

METHODS:

The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.

RESULTS:

Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education.

CONCLUSIONS:

We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied.

PMID:
22315259
PMCID:
PMC3278055
DOI:
10.1378/chest.11-2295
[Indexed for MEDLINE]
Free PMC Article

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