Thromb Haemost 2013; 110(06): 1087-1107
DOI: 10.1160/TH13-06-0443
Position Paper
Schattauer GmbH

Vitamin K antagonists in heart disease: Current status and perspectives (Section III)

Position Paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease
Raffaele De Caterina***
1   Cardiovascular Division, Ospedale SS. Annunziata, G. d’Annunzio University, Chieti, Italy
,
Steen Husted***
2   Medical-Cardiological Department, Aarhus Sygehus, Aarhus, Denmark
,
Lars Wallentin***
3   Cardiology, Uppsala Clinical Research Centre and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
,
Felicita Andreotti**
4   institute of Cardiology, Catholic University, Rome, Italy
,
Harald Arnesen**
5   Medical Department, Oslo University Hospital, Ulleval, Norway
,
Fedor Bachmann**
6   Department of Medicine, University of Lausanne, Lausanne, Switzerland
,
Colin Baigent**
7   Cardiovascular Science, Oxford University, Oxford, UK
,
Kurt Huber**
8   3rd Department of Medicine, Wilhelminenspital, Vienna, Austria
,
Jørgen Jespersen**
9   Unit for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark
,
Steen Dalby Kristensen**
10   Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
,
Gregory Y. H. Lip**
11   Haemostasis Thrombosis & Vascular Biology Unit, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
,
Joaõ Morais**
12   Cardiology, Leiria Hospital, Leiria, Portugal
,
Lars Hvilsted Rasmussen**
13   Department of Cardiology, Thrombosis Center Aalborg, Aarhus University Hospital, Aalborg, Denmark
,
Agneta Siegbahn**
14   Coagulation and Inflammation Science, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
,
Freek W. A. Verheugt**
15   Cardiology, Medical Centre, Radboud University Nijmegen, Nijmegen, Netherlands
,
Jeffrey I. Weitz**
16   Thrombosis & Atherosclerosis Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received: 05 June 2013

Accepted after minor revision: 19 August 2013

Publication Date:
30 November 2017 (online)

Summary

Oral anticoagulants are a mainstay of cardiovascular therapy, and for over 60 years vitamin K antagonists (VKAs) were the only available agents for long-term use. VKAs interfere with the cyclic inter-conversion of vitamin K and its 2,3 epoxide, thus inhibiting γ-carboxylation of glutamate residues at the amino-termini of vitamin K-dependent proteins, including the coagulation factors (F) II (prothrombin), VII, IX and X, as well as of the anticoagulant proteins C, S and Z. The overall effect of such interference is a dose-dependent anticoagulant effect, which has been therapeutically exploited in heart disease since the early 1950s. In this position paper, we review the mechanisms of action, pharmacological properties and side effects of VKAs, which are used in the management of cardiovascular diseases, including coronary heart disease (where their use is limited), stroke prevention in atrial fibrillation, heart valves and/or chronic heart failure. Using an evidence-based approach, we describe the results of completed clinical trials, highlight areas of uncertainty, and recommend therapeutic options for specific disorders. Although VKAs are being increasingly replaced in most patients with non-valvular atrial fibrillation by the new oral anticoagulants, which target either thrombin or FXa, the VKAs remain the agents of choice for patients with atrial fibrillation in the setting of rheumatic valvular disease and for those with mechanical heart valves.

* Coordinating Committee Member


** Task Force Member.


 
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