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Author: Admin | 2025-04-28
20% increase or decrease in the total weekly dosage is recommended.6,7 Patients should be provided with the simplest regimen to achieve the new total weekly dosage. Drug and Food Interactions. Vitamin K antagonists are subject to many drug interactions. Select drug-drug interactions that are considered to potentiate or inhibit the effects of vitamin K antagonists are listed in Table 4.8 When an interacting drug is initiated or discontinued, more frequent INR checks are recommended. The timing depends on the type of interaction, what the interacting drug is, and the clinical judgement of the physician. Select Vitamin K Antagonist Drug-Drug Interactions" description="*—Multiple medications increase bleeding risk because of antiplatelet activity (e.g., aspirin, salicylates, nonsteroidal anti-inflammatory drugs).Information from reference 8."> Foods with high vitamin K concentrations, such as leafy green vegetables, have the potential to partially reverse anticoagulation effects of the vitamin K antagonist.4 A consistent diet is more important than limiting dietary vitamin K. LOW-MOLECULAR-WEIGHT HEPARIN Considerations for parenteral medications are provided in eTable A. Dalteparin (Fragmin) and enoxaparin (Lovenox) are commonly used LMWHs in clinical practice. LMWH is derived from unfractionated heparin and has an increased affinity for factor Xa relative to thrombin.4 LMWH's anticoagulant effect is primarily from factor Xa inhibition because of its smaller size and its lessened ability to inactivate thrombin compared with unfractionated heparin. Subcutaneous LMWH has a predictable absorption and degree of anticoagulation, so monitoring with anti–factor Xa levels is not routinely recommended. Although LMWH has a similar bleeding risk and lower heparin-induced thrombocytopenia risk
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