PMID- 18574268
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20220321
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 6 Suppl
DP  - 2008 Jun
TI  - Hemorrhagic complications of anticoagulant and thrombolytic treatment: American 
      College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th 
      Edition).
PG  - 257S-298S
LID - S0012-3692(08)60120-8 [pii]
LID - 10.1378/chest.08-0674 [doi]
AB  - This article about hemorrhagic complications of anticoagulant and thrombolytic 
      treatment is part of the Antithrombotic and Thrombolytic Therapy: American 
      College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th 
      Edition). Bleeding is the major complication of anticoagulant and fibrinolytic 
      therapy. The criteria for defining the severity of bleeding vary considerably 
      between studies, accounting in part for the variation in the rates of bleeding 
      reported. The major determinants of vitamin K antagonist (VKA)-induced bleeding 
      are the intensity of the anticoagulant effect, underlying patient 
      characteristics, and the length of therapy. There is good evidence that VKA 
      therapy, targeted international normalized ratio (INR) of 2.5 (range, 2.0-3.0), 
      is associated with a lower risk of bleeding than therapy targeted at an INR > 
      3.0. The risk of bleeding associated with IV unfractionated heparin (UFH) in 
      patients with acute venous thromboembolism is < 3% in recent trials. This 
      bleeding risk may increase with increasing heparin dosages and age (> 70 years). 
      Low-molecular-weight heparin (LMWH) is associated with less major bleeding 
      compared with UFH in acute venous thromboembolism. Higher doses of UFH and LMWH 
      are associated with important increases in major bleeding in ischemic stroke. In 
      ST-segment elevation myocardial infarction, addition of LMWH, hirudin, or its 
      derivatives to thrombolytic therapy is associated with a small increase in the 
      risk of major bleeding, whereas treatment with fondaparinux or UFH is associated 
      with a lower risk of bleeding. Thrombolytic therapy increases the risk of major 
      bleeding 1.5-fold to threefold in patients with acute venous thromboembolism, 
      ischemic stroke, or ST-elevation myocardial infarction.
FAU - Schulman, Sam
AU  - Schulman S
AD  - From the Thrombosis Service, McMaster Clinic, HHS-General Hospital, Hamilton, ON, 
      Canada. Electronic address: schums@mcmaster.ca.
FAU - Beyth, Rebecca J
AU  - Beyth RJ
AD  - Rehabilitation Outcomes Research Center NF/SG Veterans Health System, 
      Gainesville, FL.
FAU - Kearon, Clive
AU  - Kearon C
AD  - McMaster University Clinic, Henderson General Hospital, Hamilton, ON, Canada.
FAU - Levine, Mark N
AU  - Levine MN
AD  - Henderson Research Centre, Hamilton, ON, Canada.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Hirudins)
RN  - 0 (Polysaccharides)
RN  - 12001-79-5 (Vitamin K)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/*adverse effects
MH  - Brain Ischemia/drug therapy
MH  - Evidence-Based Medicine
MH  - Fondaparinux
MH  - Hemorrhage/*chemically induced
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Hirudins/adverse effects
MH  - Humans
MH  - International Normalized Ratio
MH  - Myocardial Infarction/drug therapy
MH  - Polysaccharides/adverse effects
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Thrombolytic Therapy/*adverse effects
MH  - Treatment Outcome
MH  - Venous Thromboembolism/drug therapy
MH  - Vitamin K/adverse effects/antagonists & inhibitors
EDAT- 2008/07/24 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/24 09:00
PHST- 2008/07/24 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/24 09:00 [entrez]
AID - S0012-3692(08)60120-8 [pii]
AID - 10.1378/chest.08-0674 [doi]
PST - ppublish
SO  - Chest. 2008 Jun;133(6 Suppl):257S-298S. doi: 10.1378/chest.08-0674.