Perspectives: Lessons Learned From VKAs

Raffaele De Caterina

Raffaele De Caterina


  • Professor and Director
  • Institute of Cardiology
  • University Chieti, Italy
  • Consultant
  • "G. Monasterio" Foundation for Medical Research
  • Pisa, Italy


How the risk of stroke and bleeding affects decisions on selecting anticoagulant therapy

How do we choose an anticoagulant? A patient that has a very high risk of stroke, let’s say, a CHADS2 score of 4, especially if this is a patient that may have already suffered a stroke, and so the risk of a second stroke is much higher after a first episode, so this patient is in a high-risk category that is represented in clinical studies.

It’s important to make sure the specific treatment option has strong supporting clinical data that represents the patient you are treating.

Another condition that may affect choice of agent is renal impairment, which may affect the plasma concentration of an agent. There is little or no clinical data in patients with a creatinine clearance less than 30 mL/min, so using some agents in patients with severely impaired kidney function should be carefully considered.

Now for the patient in the lower range of creatinine clearance, for example between 30 and 50 mL/min the efficacy and safety may vary for some agents, especially for a drug that is vastly excreted via the kidneys.

Adherence is extremely important to keep the patient at a proper level of anticoagulation.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.