Rational Pharmacotherapy in Cardiology

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The safety of anticoagulant therapy is discussed. Warfarin position in prevention of thrombotic complications is analyzed according to the evidence base medicine approach. Possible hemorrhagic complications of warfarin are described and accompanied with clinical cases. Possibility of renewal of anticoagulant therapy in patients after hemorrhagic complications is discussed.

About the Author

E. S. Kropacheva
Russian Cardiology Research and Production Complex
Russian Federation
ul. Tretya Cherepkovskaya 15a, 121552 Moscow


1. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/Ame￾rican Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006;48:854-906.

2. Ansell J., Hirsh J., Jacobson A. et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):160S-198S.

3. Hirsh J., Fuster V., Ancell J. et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. Circulation 2003;107:1692- 711.

4. Fihn S.D., McDommel M., Matin D. et al. Risk factors for complications of chronic anticoagulation. A multicenter study. Warfarin Optimized Outpatient Follow￾up Study Group. Ann Intern Med 1993;118:511-20.

5. Copland M., Walker I.D, Tait R.C. Oral anticoagulation and hemorrhagic complications in an elderly population with atrial fibrillation. Arch Intern Med 2001;161(17):2125-8.

6. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. N Engl J Med 1990;323(22):1505-11.

7. Gorter J.W. Major bleeding during anticoagulation after cerebral ischemia: patterns and risk factors. Stroke Prevention In Reversible Ischemia Trial (SPIRIT). European Atrial Fibrillation Trial (EAFT) study groups. Neurology 1999;53:1319-27.

8. Levine M.N., Raskob G., Landefeld S. et al. Hemorrhagic complication of anticoagulant treatment. Chest 2001;119(1 Suppl):108S-121S.

9. Landefeld C.S., Goldman L. Mayor bleeding in outpatients treated with warfarin : incidence and prediction by factors known at the start of outpatient therapy. Am J Med 1989;87:144-52.

10. Pengo V., Legnani C., Noventa F. et al. ISCOAT Study Group (Italian Study on Complications of Oral Anticoagulant Therapy). Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding. A Multicenter Inception Cohort Study. Thromb Haemost 2001;85:418-22.

11. Gage B., Yan Y., Milligan P. et al. Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF). Am He￾art J 2006;151(3):713-9.

12. Rieder M.J., Reiner A.P., Gage B.F. et al. Effect of VKORC1 haplotypes on transcriptional regulation and warfarin dose. N Engl J Med 2005;352(22):2285-93.

13. Scordo M.G., Pengo V., Spina E. et al. Influence of CYP2C9 and CYP2C19 genetic polymorphisms on warfarin maintenance dose and metabolic clearance. Clin Pharmacol Ther 2002;72:702-10.

14. Hermida J., Zarza J., Alberca I. et al. Differential effects of 2C9*3 and 2C9*2 variants of cytochrome P-450 CYP2C9 on sensitivity to acenocoumarol. Blood 2002;99:4237-9.

15. Joffe H.V., Xu R., Johnson F.B. et al. Warfarin dosing and cytochrome P450 2C9 polymorphisms. Thromb Haemost 2004;91:1123-8.

16. Сироткина О.В., Улитина А.С., Тараскина А.Е. и др. Аллельные варианты CYP2C9*2 и CYP2C9*3 гена цитохрома CYP2C9 в популяции Санкт-Петербурга и их клиническое значение при антикоагулянтной терапии варфарином. Российский кардиологический журнал 2004;(6):24-31

17. Михеева Ю.А., Кропачева Е.С., Игнатьев И.В. и др. Полиморфизм гена цитохрома Р4502С9(CYP2C9) и безопасность терапии варфарином. Кардиология 2008;(3):77-83.

18. Сычев Д.А., Михеева Ю.А., Кропачева Е.С. и др. Влияние полиморфизма гена CYP2C9 на фармакокинетику и фармакодинамику варфарина у больных с постоянной формой фибрилляции предсердий. Клин мед 2007;(1):57-60.

19. Higashi M.K., Veenstra D.L., Kondo L.M. et al. Association between CYP2C9 genetic variants and anticoagulation-related outcomes during warfarin therapy. JAMA 2002;287:1690-8.

20. Панченко Е.П., Михеева Ю.А., Сычев Д.А. и др. Новый подход к повышению безопасности лечения варфарином (результаты фармакогенетического исследования). Кардиологический вестник 2008;3(2):38-44.

21. Aguilar M.I., Hart R.G., Kase C.S. et al. Treatment of Warfarin-Associated Intracerebral Hemorrhage:Literature Review and Expert Opinion. Mayo Clin Proc 2007;82:82-92.

22. Eckman M.H., Rosand J., Knudsen K.A. et al. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke 2003;34:1710-6.

23. Bertram M., Bonsanto M., Hacke W. et al. Managing the therapeutic dilemma: patients with spontaneous intracerebral hemorrhage and urgent need for anti￾coagulation. J Neurol 2000;247:209-14.

24. Butler A.C., Tait R.C. Restarting anticoagulation in prosthetic heart valve patients after intracranial haemorrhage: a 2-year follow-up. Br J Haematol 1998;103:1064- 6.

25. Nakagawa T., Kubota T., Handa Y. et al. Intracranial hemorrhage due to longterm anticoagulant therapy in patients with prosthetic heart valves—four case reports. Neurol Med Chir (Tokyo) 1995;35(3):156-9.

26. Nagano N., Tabata H., Hashimoto K. Anticoagulant-related intracerebral hemorrhage in patients with prosthetic heart valves—report of two cases. Neurol Med Chir (Tokyo) 1991;31:743-5.

27. Phan T.G., Koh M., Wijdicks E.F. Safety of discontinuation of anticoagulation in patients with intracranial hemorrhage at high thromboembolic risk. Arch Neurol 2000;57:1710-3.

28. Wijdicks E.F., Schievink W.I., Brown R.D. et al. The dilemma of discontinuation of anticoagulation therapy for patients with intracranial hemorrhage and mechanical heart valves. Neurosurgery 1998;42:769-73.

29. Babikian V.L., Kase C.S., Pessin M.S. et al. Resumption of anticoagulation after intracranial bleeding in patients with prosthetic heart valves. Stroke 1988;19:407- 8.

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