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Sopiva INR-taso laskimoveritulpan hoidossa

Näytönastekatsaukset
Elina Armstong
5.5.2015

Näytön aste: A

INR 2,0–3,0 on yleensä sopiva antikoagulaation tavoitetaso sekä SLT- että KE-potilaita hoidettaessa.

INR 2,0–3,0 on yleensä sopiva antikoagulaation tavoitetaso, kun hoidetaan syvää laskimotukosta ja keuhkoemboliaa sairastavia potilaita.

Lukuisissa kontrolloiduissa tutkimuksissa «Mohiuddin SM, Hilleman DE, Destache CJ ym. Efficac...»1, «Hull R, Delmore T, Genton E ym. Warfarin sodium ve...»2, «Hull R, Delmore T, Carter C ym. Adjusted subcutane...»3, «Hull R, Hirsh J, Jay R ym. Different intensities o...»4, «Gallus A, Jackaman J, Tillett J ym. Safety and eff...»5, «Hull RD, Raskob GE, Rosenbloom D ym. Heparin for 5...»6 on osoitettu, että sopiva INR-tavoite on 2,5 ja hoitoalue on INR 2–3.

Tätä tukevat retrospektiiviset vertailevat tutkimukset, joiden mukaan laskimoveritulpan uusiutumisten ilmaantumisvaara suurenee, jos INR on alle 1,9 «Schulman S, Lockner D. Relationship between thromb...»7verrattuna tasoon 2,0–3,0 «Kearon C, Akl EA, Comerota AJ ym. Antithrombotic t...»8, «Palareti G, Leali N, Coccheri S ym. Bleeding compl...»9, «Geerts WH, Jay RM. Oral anticoagulants in the prev...»10.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kirjallisuutta

  1. Mohiuddin SM, Hilleman DE, Destache CJ ym. Efficacy and safety of early versus late initiation of warfarin during heparin therapy in acute thromboembolism. Am Heart J 1992;123:729-32 «PMID: 1539524»PubMed
  2. Hull R, Delmore T, Genton E ym. Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med 1979;301:855-8 «PMID: 384248»PubMed
  3. Hull R, Delmore T, Carter C ym. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med 1982;306:189-94 «PMID: 7033782»PubMed
  4. Hull R, Hirsh J, Jay R ym. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 1982;307:1676-81 «PMID: 6755255»PubMed
  5. Gallus A, Jackaman J, Tillett J ym. Safety and efficacy of warfarin started early after submassive venous thrombosis or pulmonary embolism. Lancet 1986;2:1293-6 «PMID: 2878173»PubMed
  6. Hull RD, Raskob GE, Rosenbloom D ym. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. N Engl J Med 1990;322:1260-4 PubMed
  7. Schulman S, Lockner D. Relationship between thromboembolic complications and intensity of treatment during long-term prophylaxis with oral anticoagulants following DVT. Thromb Haemost 1985;53:137-40 «PMID: 3992513»PubMed
  8. Kearon C, Akl EA, Comerota AJ ym. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e419S-94S «PMID: 22315268»PubMed
  9. Palareti G, Leali N, Coccheri S ym. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet 1996;348:423-8 «PMID: 8709780»PubMed
  10. Geerts WH, Jay RM. Oral anticoagulants in the prevention and treatment of venous thromboembolism. Kirjassa: Poller J, Hirsh J (toim.) Oral Anticoagulants. London: Arnold; 1996:97-122