Chest
Volume 114, Issue 5, Supplement, November 1998, Pages 511S-523S
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Hemorrhagic Complications of Anticoagulant Treatment

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Oral Anticoagulants

The major determinants of oral anticoagulant-induced bleeding are the intensity of the anticoagulant effect, patient characteristics, the use of drugs that interfere with hemostasis, and the length of therapy.

Heparin

Heparin is usually given in low doses by subcutaneous injection to prevent venous thrombosis (prophylactic heparin), in higher doses to treat patients with acute venous thromboembolism or with acute coronary syndromes (therapeutic heparin), and in very high doses in patients during open heart surgery.

In this chapter, we will discuss only bleeding associated with therapeutic heparin. Heparin has the potential to induce bleeding by inhibiting blood coagulation, by impairing platelet function,101

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References (138)

  • AltmanR et al.

    Aspirin and prophylaxis of thromboembolic complications in patients with substitute heart valves

    J Thorac Cardiovasc Surg

    (1976)
  • ChesebroJH et al.

    Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole

    Am J Cardiol

    (1983)
  • DaleJ et al.

    Prevention of arterial thromboembolism with acetylsalicylic acid: a controlled study in patients with aortic ball valves

    Am Heart J

    (1977)
  • PetersenP et al.

    Placebo-controlled randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study

    Lancet

    (1989)
  • ConnollySJ et al.

    Canadian atrial fibrillation anticoagulation study

    J Am Coll Cardiol

    (1991)
  • BjerkelundCJ.

    Therapeutic level in long term anticoagulant therapy after myocardial infarction: its relation to recurrent infarction and sudden death

    Am J Cardiol

    (1963)
  • HarvaldB et al.

    Long term anticoagulant therapy after myocardial infarction

    Lancet

    (1962)
  • BynumLJ et al.

    Low dose heparin therapy in the long term management of venous thromboembolism

    Am J Med

    (1979)
  • GallusAS et al.

    Safety and efficacy of warfarin started early after submassive venous thrombosis or pulmonary embolism

    Lancet

    (1986)
  • SiragusaS et al.

    Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: results of a meta-analysis

    Am J Med

    (1996)
  • LevineMN et al.

    Hemorrhagic complications of long-term anticoagulant therapy

    Chest

    (1986)
  • LevineMN et al.

    Hemorrhagic complications of long-term anticoagulant therapy

    Chest

    (1989)
  • LevineMN et al.

    Hemorrhagic complications of anticoagulant treatment

    Chest

    (1992)
  • HullR et al.

    Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis

    N Engl J Med

    (1982)
  • SaourJN et al.

    Trial of different intensities of anticoagulation in patients with prosthetic heart valves

    N Engl J Med

    (1990)
  • HylekE et al.

    Risk factors for intracranial hemorrhage in outpatients taking warfarin

    Ann Intern Med

    (1994)
  • Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data form five randomized controlled trials

    Arch Intern Med

    (1994)
  • Secondary prevention in non-rheumatic atrial fibrillation after transient ischemic attack or minor stroke

    Lancet

    (1993)
  • HylekEM et al.

    An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation

    N Engl J Med

    (1996)
  • BernMM et al.

    Very low doses of warfarin can prevent thrombosis in central vein catheters: a randomized prospective trial

    Ann Intern Med

    (1990)
  • Randomised double-blind trial of fixed low-dose warfarin with aspirin after myocardial infarction

    Lancet

    (1997)
  • The Medical Research Council's general practice research framework

    Lancet

    (1998)
  • FilmSD et al.

    Risk factors for complications of chronic anticoagulation: a multi-centre study

    Ann Intern Med

    (1993)
  • Bleeding during antithrombotic therapy in patients with atrial fibrillation

    Arch Intern Med

    (1996)
  • Optimal oral anticoagulant therapy in patients WITH nonrheumatic atrial fibrillation and recent cerebral ischemia

    N Engl J Med

    (1995)
  • Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia

    N Engl J Med

    (1995)
  • PeymanMA.

    The significance of hemorrhage during treatment of patients with coumarin anticoagulants

    Acta Med Scand

    (1958)
  • LaunbjergJ et al.

    Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1,010 treatment years in 551 outpatients

    J Intern Med

    (1991)
  • RoosJ et al.

    The cause of bleeding during anticoagulant treatment

    Acta Med Scand

    (1965)
  • PollardJW et al.

    Problems associated with long-term anticoagulant therapy

    Circulation

    (1962)
  • CoonWW et al.

    Hemorrhagic complications of anticoagulant therapy

    Arch Intern Med

    (1974)
  • van der MeerFJ et al.

    Bleeding complications in oral anticoagulant therapy: an analysis of risk factors

    Arch Intern Med

    (1993)
  • ForfarJC.

    A 7-year analysis of hemorrhage in patients in long-term anticoagulant treatment

    Br Heart J

    (1979)
  • McInnesGT et al.

    The performance of clinics for outpatient control of anticoagulation

    J R Coll Physicians Lond

    (1987)
  • DavisFB et al.

    Management of anticoagulation in outpatients: experience with an anticoagulation service in a municipal hospital setting

    Arch Intern Med

    (1977)
  • GurwitzJH et al.

    Age-related risks of long term oral anticoagulant therapy

    Arch Intern Med

    (1988)
  • AlbersGW.

    Atrial fibrillation and stroke: three new studies, three remaining questions

    Arch Intern Med

    (1994)
  • NelsonPH et al.

    Risk of complications during intravenous heparin therapy

    West J Med

    (1982)
  • LundstromT et al.

    Hemorrhagic and thromboembolic complications in patients with atrial fibrillation on anticoagulant prophylaxis

    J Intern Med

    (1989)
  • FullerJA et al.

    Experiences with long-term anticoagulant treatment

    Lancet

    (1959)
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