Department of Medicine, McMaster University and St Joseph's Hospital, Room L301, 50 Charlton Ave East, Hamilton, ON, L8N 4A6, Canada.
J Thromb Thrombolysis. 2011 Apr;31(3):249-58. doi: 10.1007/s11239-011-0555-z.
Millions of patients worldwide are prescribed vitamin K antagonists for a variety of medical conditions annually. Despite widespread and long-standing experience with these medications, medical care providers are often confronted with challenging clinical situations. Vitamin K antagonists have a narrow therapeutic index secondary to intrinsic patient characteristics and extrinsic factors including a propensity for drug-drug interactions. Clinicians are required to titrate doses according to the measured international normalized ratio for each individual, balancing the risk of bleeding with preventing thrombosis. The risk of major bleeding associated with vitamin K antagonists has been reported to range from 1 to 3% per year. This narrative review will provide an overview of the most commonly used vitamin K antagonists and discuss the importance of assessing quality of anticoagulation with respect to clinical outcomes. Practical approaches to managing excessive anticoagulation, variable anticoagulation, and anticoagulation failure will be provided, drawing on evidence where applicable and expert opinion where evidence is limited.
全球每年有数百万患者因各种医疗状况而被开处维生素 K 拮抗剂。尽管这些药物的使用已经非常广泛且由来已久，但医疗保健提供者经常面临具有挑战性的临床情况。维生素 K 拮抗剂的治疗指数狭窄，这是由于内在的患者特征和外在因素所致，包括药物相互作用的倾向。临床医生需要根据每个人的测量国际标准化比值来调整剂量，在预防血栓形成的同时平衡出血的风险。据报道，与维生素 K 拮抗剂相关的大出血风险为每年 1%至 3%。本叙述性综述将概述最常用的维生素 K 拮抗剂，并讨论评估抗凝质量与临床结局的重要性。将提供处理过度抗凝、抗凝变化和抗凝失败的实用方法，在适用的情况下引用证据，在证据有限的情况下引用专家意见。
