The Standard is Still the Standard or Why an INR of 2–3 is Still the Optimal Intensity for Secondary Prevention of Venous Thromboembolism
- Michael J Kovacs
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The optimal intensity of warfarin anticoagulation for secondary prevention of venous thromboembolism is debatable. Recent studies have shed light on the issue. The two pivotal studies, ELATE and PREVENT, are reviewed and discussed. Although the ELATE and PREVENT studies offer different conclusions, the results of the two studies are consistent with each other. Low intensity warfarin is more efficacious than placebo, although it is less efficacious than standard intensity and offers no safety advantage. For long term secondary prophylaxis of spontaneous venous thromboembolism, the optimal INR intensity of warfarin remains 2.0–3.0.
- Buller HR, Agnelli G, Hull RD, Hyers T M, Prins M H, Raskob G E Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):401S–428S.
- Kearon C, Ginsberg JS, Anderson DR et al. Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost 2004;2(5):743–749. CrossRef
- Prins MH, Marchiori A. Risk of recurrent venous thomboembolism—expanding the frontier. Thromb Haemost 2002;87(1):1–3.
- Kearon C, Gent M, Hirsh J et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999;340(12):901–907. CrossRef
- Agnelli G, Prandoni P, Santamaria MG et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med 2001;345(3):165–169. CrossRef
- Boutitie F, Pinede L, Schulman S et al. Incidence of recurrent venous thromboembolism according to duration of vitamin K antagonists: Results of a meta-analysis on individual data. Blood 104, 204a. 11-16-2004. Ref Type: Abstract.
- Schulman S, Granqvist S, Holmstrom M et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. N Engl J Med 1997;336(6):393–398. CrossRef
- Kearon C, Ginsberg JS, Kovacs MJ et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003;349(7):631–639. CrossRef
- Ridker PM, Goldhaber SZ, Danielson E et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003;348(15):1425–1434. CrossRef
- Fang MC, Chang Y, Hylek EM et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 2004;141(10):745–752.
- Perret-Guillaume C, Wahl DG. Low-dose warfarin in atrial fibrillation leads to more thromboembolic events without reducing major bleeding when compared to adjusted-dose—a meta-analysis. Thromb Haemost 2004;91(2):394–402.
- Kearon C, Julian JA, Ginsberg J. Low-intensity versus conventional-intensity warfarin for prevention of recurrent venous thromboembolism. N Engl J Med 2003;349:2166, author reply.
- The Standard is Still the Standard or Why an INR of 2–3 is Still the Optimal Intensity for Secondary Prevention of Venous Thromboembolism
Journal of Thrombosis and Thrombolysis
Volume 21, Issue 1 , pp 53-56
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- Kluwer Academic Publishers
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- venous thromboembolism
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- Michael J Kovacs (1)
- Author Affiliations
- 1. London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada