Recommendations For Anticoagulant Therapy Research Articles

Atrial Fibrillation and Thromboembolism

Atrial Fibrillation and Thromboembolism

Oral Anticoagulants

We read with great interest, the article by Hirsh et al 1. Hirsh J. Dalen J.E. Deykin D. Poller L. Oral anticoagulants: mechanisms of action, clinical effectiveness, and optimal therapeutic range. Chest. 1992; 102: 26S-312S PubMed Google Scholar published in the October, 1992 supplement to Chest. Their article is a useful review of oral anticoagulants and the new recommendations for anticoagulant therapy. We wish to bring your attention to some apparent confusion regarding the new standards for therapeutic ranges of oral anticoagulants. We believe the confusion resulted from the information in Tables 2 and 4. Although the text of the article discusses the standards for recommended therapeutic ranges for oral anticoagulant therapy as they appear in Table 2, at least one other publication has printed recommendations based on the information in Table 4. 2. Karpman H.L. INR—the new standard for monitoring oral anticoagulant therapy. Intern Med Alert. 1992; (Dec 15): 178-179 Google Scholar The differences between Tables 2 and 4 are in the international normalized ratio ranges for prevention of recurrent myocardial infarction and reduction of mortality post myocardial infarction.

Oral Anticoagulants-To the Editor

I thank Drs. Smith and Elkhatib for their comments on our article, “Oral Anticoagulants: Mechanism of Action, Clinical Effectiveness, and Optimal Therapeutic Range,” which appeared in the October, 1992, Supplement to Chest. Table 2 provides the recommended indication for warfarin and the therapeutic ranges for these indications. Table 4 provides information on the minimum effective international normalized ratio (INR) values for each potential indication, based on the results of randomized studies. Although the use of warfarin was not recommended for the prevention of death or reinfarction in patients with acute myocardial infarction, the drug is effective for this indication. The right hand column of Table 4 provides the recommended INR based on hard evidence, if a decision is made by a physician to use warfarin to treat patients with acute myocardial infarction. Oral AnticoagulantsCHESTVol. 105Issue 6PreviewWe read with great interest, the article by Hirsh et al1 published in the October, 1992 supplement to Chest. Their article is a useful review of oral anticoagulants and the new recommendations for anticoagulant therapy. We wish to bring your attention to some apparent confusion regarding the new standards for therapeutic ranges of oral anticoagulants. We believe the confusion resulted from the information in Tables 2 and 4. Although the text of the article discusses the standards for recommended therapeutic ranges for oral anticoagulant therapy as they appear in Table 2, at least one other publication has printed recommendations based on the information in Table 4. Full-Text PDF