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Anticoagulation in ischaemic heart disease
  1. R De Cristofaro
  1. Correspondence to:
    Dr Raimondo De Cristofaro
    Haemostasis Research Centre, Institute of Internal Medicine and Geriatrics, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy; rdecristofaro{at}rm.unicatt.it

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Although treatments with oral anti-vitamin K agents have become more refined and safer over the years, physicians are reluctant to prescribe these agents for fear they will cause bleeding, particular in patients with ischaemic heart disease

Oral anti-vitamin K agents (AVKs) are the most frequently prescribed anticoagulants, and the fourth most prescribed cardiovascular agents. Even though four decades have passed since AVKs were first used to prevent thromboembolic disease, studies continue to discover and refine techniques that make treatment with this agent safer and more effective. In general clinical practice, physicians are often reluctant to prescribe AVKs, in part because they are not familiar with techniques for administering the drugs safely and fear that AVKs will cause bleeding. Patients treated with AVKs do require close monitoring to avoid bleeding, but it has been shown that these drugs prevent about 20 strokes for every bleeding episode that they cause. AVKs are mostly used for prevention of thromboembolic disorders in clinical settings such as atrial fibrillation, previous deep venous thrombosis (DVT)/pulmonary embolism (PE), and implantation of mechanical heart prostheses. Although AVKs are widely used in these conditions, the incidence and therapeutic management of ischaemic heart disease in patients receiving anticoagulant treatment need to be investigated further.

ORAL ANTICOAGULATION AND ISCHAEMIC HEART DISEASE: A DISPUTED LOVE

Thrombolysis is the mainstay in the antithrombotic treatment of patients admitted to hospital with acute myocardial infarction (AMI) with elevation of ST segment (STEMI) who are not candidates for PCI. Several fibrinolytic agents with different pharmacodynamic and pharmacokinetic profiles are routinely used.1,2 Among patients with STEMI treated with thrombolysis, a significant proportion comprises subjects already under AVK treatment for previous acute coronary syndrome (ACS)/AMI or other conditions where the use of AVKs is mandatory, such as atrial fibrillation, heart failure, …

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