Anticoagulants in heart disease: current status and perspectives.

List of abbreviations . . . . . . . . . . . . . . . . . . 2 Preamble: purposes and scope of the task force . . 2 Blood coagulation . . . . . . . . . . . . . . . . . . . . 3 Haemostasis . . . . . . . . . . . . . . . . . . . . . 3 Arterial thrombosis . . . . . . . . . . . . . . . . . 3 Tissue factor . . . . . . . . . . . . . . . . . . . . . 3 Tissue factor pathway inhibitor . . . . . . . . . . 3 Cellular control of coagulation . . . . . . . . . . 3 Cross-talk between coagulation and inflammation . . . . . . . . . . . . . . . . . . . . 4 Epidemiology of anticoagulant therapy in heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Coronary heart disease . . . . . . . . . . . . . . . 5 Non-valvular atrial fibrillation . . . . . . . . . . . 5 Prosthetic heart valves . . . . . . . . . . . . . . . 6 Heart failure . . . . . . . . . . . . . . . . . . . . . 6 Parenteral anticoagulants: general pharmacology . . 6 Heparin derivatives . . . . . . . . . . . . . . . . . 6 Unfractionated heparin . . . . . . . . . . . . . 6 Mechanism of action . . . . . . . . . . . . . 6 Pharmacokinetics . . . . . . . . . . . . . . . 7 Dosing and monitoring . . . . . . . . . . . . 7 Side effects . . . . . . . . . . . . . . . . . . 8 Low molecular weight heparins . . . . . . . . 8 Mechanism of action . . . . . . . . . . . . . 8 Pharmacokinetics . . . . . . . . . . . . . . . 8 Dosing and monitoring . . . . . . . . . . . . 9 Side effects . . . . . . . . . . . . . . . . . . 9 Pentasaccharides: fondaparinux and idraparinux . . . . . . . . . . . . . . . . . . . . 9 Mechanism of action . . . . . . . . . . . . . 9 Dosing . . . . . . . . . . . . . . . . . . . . . 9 Monitoring . . . . . . . . . . . . . . . . . . . 9 Side effects . . . . . . . . . . . . . . . . . . 9 Parenteral direct thrombin inhibitors . . . . . . . 10 Compared pharmacological properties of unfractionated heparin, low-molecular weight heparins, pentasaccharides, and direct thrombin inhibitors . . . . . . . . . . . . . . . . . . . . . . . 10 Vitamin K antagonists: general pharmacology . . . . 11 Mechanism of action . . . . . . . . . . . . . . . . 11 Vitamin K anticoagulant therapy: interference with foods and drugs . . . . . . . . . . . . . . . . 11 Laboratory control . . . . . . . . . . . . . . . . . 11 Dosing . . . . . . . . . . . . . . . . . . . . . . . . 12 Point-of-care testing and prothrombin time monitors . . . . . . . . . . . . . . . . . . . . . . . 13 Self-management of oral anticoagulation . . . . 13 Oral direct thrombin inhibitors: general pharmacology . . . . . . . . . . . . . . . . . . . . . . 14 Parenteral anticoagulants: clinical indications . . . . 14 Unfractionated heparin . . . . . . . . . . . . . . . 14 Low molecular weight heparins . . . . . . . . . . 14 Non-ST-elevation acute coronary syndromes . 14 ST-elevation acute myocardial infarction treated with fibrinolytics . . . . . . . . . . . . 15 Elective percutaneous coronary interventions 15 Percutaneous coronary interventions in the setting of acute coronary syndromes . . . . . 16 Pentasaccharides . . . . . . . . . . . . . . . . . . 16 Fondaparinux . . . . . . . . . . . . . . . . . . . 16 Idraparinux . . . . . . . . . . . . . . . . . . . . 17 Intravenous direct thrombin inhibitors . . . . . . 17 Vitamin K antagonists . . . . . . . . . . . . . . . . . 19 Coronary heart disease . . . . . . . . . . . . . . . 19 Primary prevention . . . . . . . . . . . . . . . 19 Acute coronary syndromes . . . . . . . . . . . 19 Coronary bypass graft surgery . . . . . . . . . 19 Percutaneous coronary interventions . . . . . 19 Atrial fibrillation . . . . . . . . . . . . . . . . . . 19 Artificial heart valves . . . . . . . . . . . . . . . . 19 Heart failure . . . . . . . . . . . . . . . . . . . . . 20 Oral direct thrombin inhibitors: clinical developments . 20 Oral Factor Xa inhibitors: clinical developments . . 20 Bleeding risk and bleeding management during anticoagulant therapy . . . . . . . . . . . . . . . . . 21 General risk factors for bleeding . . . . . . . . . 21 Unfractionated heparin and low-molecular weight heparins . . . . . . . . . . . . . . . . . 21 Pentasaccharides . . . . . . . . . . . . . . . . 21 Direct thrombin inhibitors . . . . . . . . . . . 21 Vitamin K antagonists . . . . . . . . . . . . . . 22