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Self-management and self-monitoring for patients treated with a vitamin K antagonist

Until recently VKAs, such as warfarin, have been the only oral anticoagulants available for clinical use. VKAs have highly unpredictable pharmacokinetics, and therefore their anticoagulant effect requires monitoring. The unpredictability of their pharmacokinetics is multifactorial, including; genetic differences in enzymes such as cytochrome p450 that metabolise VKA, environmental factors such as changes in dietary intake or absorption of vitamin K or the concurrent use of other medication that interferes with VKA uptake or metabolism. If the anticoagulation effect is higher than required there is an increased risk of bleeding and if it is too low there is a potential lack of therapeutic benefit.

Guideline summary

From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail in The 2009 Guidelines Manual. The reasons that each of these recommendations was chosen are shown in the table linking the evidence to the recommendation in the relevant chapter.

Pharmacological interventions

The pharmacological treatment of VTE is reviewed in three sections for this chapter. The first section looks at the pharmacological management of VTE in the initial stages, followed by strategies for continuing anticoagulation. The last section looks at the optimal length of time for anticoagulation.

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