Pitfalls in the Use of Anticoagulants.
Academic Article
Overview
abstract
Anticoagulants are in widespread use for the management of a variety of conditions, ranging from thrombus prevention to the treatment of arterial and venous occlusion. As with any effective therapy, recognition of adverse effects is critically important for the safe use of these drugs. Pitfalls in the use of heparins include dosing in close proximity to invasive procedures; not closely monitoring patients in whom dose adjustments may be required, such as the very obese, the elderly, and patients with renal or hepatic failure; failing to make dose adjustments during pregnancy; and not recognizing when patients are developing heparin-induced thrombocytopenia or osteoporosis. Pitfalls in the use of unfractionated heparin include delays in achieving a therapeutic activated partial thromboplastin time (aPTT) and failure to consider the effects of protein binding in acutely ill patients. A pitfall in the use of low molecular weight heparin is giving prophylactic doses when therapeutic doses are indicated. Pitfalls in the use of warfarin are stopping heparin before the warfarin is fully effective; failing to maintain the International Normalized Ratio within the therapeutic range; failing to adjust the dose of warfarin because of changes in diet, renal or hepatic failure, and exposure to new drugs; failing to stop warfarin at an appropriate interval before an invasive procedure; and giving warfarin during pregnancy. Pitfalls in the use of thrombin inhibitors include using them with thrombolytic agents; giving them in proximity to invasive procedures; not adjusting the dose for renal or hepatic failure; and failing to consider the effect of these agents on the prothrombin time when initiating warfarin therapy.
