![]() It is also important to note that there is a type of heparin flush often referred to as “Hep-Lock” that is used to maintain the patency of central lines. (See Figure 6.25.) Due to heparin being a high-alert medication, hospitals use several processes for storing and labeling the medication to help prevent errors. Heparin sodium is an anticoagulant that can be injected or used intravenously and is formulated in several dosages. Suggested patient education topics are included for each type of medication below. It is vital for nurses to provide thorough patient and caregiver education for patients prescribed anticoagulants at home. When the pharmaceutical industry began marketing modern replacements for warfarin, including dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis), they designed them to be easier to use than warfarin because no laboratory monitoring was required, but not necessarily safer. Warfarin requires close laboratory monitoring and individual dose adjustments based on PT and INR lab results. Since 1954, warfarin has been a standard but hazardous treatment for preventing blood clots. ![]() Adverse effects range from gastrointestinal bleeding to cerebral hemorrhages, resulting in over 3,000 deaths in 2016. CDC data show that adverse effects of oral anticoagulants account for more emergency department visits than any other class of drugs. Anticoagulants are commonly used by the elderly to reduce the risk of ischemic stroke, with an estimated 3.8 million people taking oral anticoagulants in 2016. Īccording to the Institute for Safe Medication Practices (ISMP) 2016 Annual Report, there is also a high risk of acute injuries for patients taking anticoagulants outside of the hospital setting. Specific interventions regarding anticoagulant therapy include standardization of protocols for withholding and restarting warfarin perioperatively, including pharmacists on rounds to provide decision support for staff administering HAMs and to reduce prescribing errors, pharmacist monitoring of anticoagulants, and pharmacist notification when rescue medications are given. Perform medication reconciliation at all transitions.Use standardized order sets and protocols.Educate staff based on evidence and best practices.The Health Research and Educational Trust focuses on reducing harm related to HAMs by 50% and recommends the following interventions to achieve this goal: The most common anticoagulant errors in acute hospital settings are administration mistakes, including incorrect dosage calculation and infusion rates. All these types of medications are included on the List of High Alert Medications (HAMs) by the Institute for Safe Medication Practices (ISMP) that require special safeguards to reduce the risk of errors or adverse effects. Antiplatelets include aspirin and other aggregation inhibitors such as clopidogrel, and thrombolytics include alteplase (tPA). Anticoagulants include the following drug classes: heparins or unfractionated heparin and low molecular weight heparin (LMWH), warfarin (Coumadin), selective factor Xa inhibitors (rivaroxaban), and direct thrombin inhibitors (dabigatran). This section will discuss medications that affect blood coagulation and includes several types of medications including anticoagulants, antiplatelets, and thrombolytics, as well as their associated reversal agents.Īnticoagulants prevent the formation of a clot by inhibiting certain types of clotting factors. Although antidotes against anticoagulant treatment are widely available, our analysis shows that in only a very small number of patients a direct, or slow-acting antidote to reverse the anticoagulant effect was used.\) Vitamin K was more frequently given in case of a higher international normalized ratio value. ![]() Antidotes were statistically significantly more frequently given in Canada as compared to other participating countries. ![]() The use of antidotes was comparable for initial and long-term treatment. Vitamin K was given to 23 (1.2%) patients, one (0.05%) patient received protamin sulfate and seven (0.4%) patients received fresh frozen plasma. Of the patients with at least one major hemorrhage, 19 (41.3%) received an antidote. Some form of antidote was given to 26 (14.4%) patients with a hemorrhage. We investigated 1877 patients treated for venous thromboembolism included in three large clinical trials, of which 181 (9.6%) had a total of 225 adjudicated bleeding episodes 46 hemorrhages being designated as major. Interestingly, it is unknown how often the use of an antidote is necessary in clinical practice. Several new anticoagulants have been developed that are likely to have some risk of bleeding complications, for which no specific antidotes are available. When a bleeding complication occurs during therapy with heparin or vitamin K antagonists, there is an option to give a specific antidote. ![]()
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