Anticoagulation Management
Anticoagulants are medicines that are used to prevent clot formation. If clot is already being formed, then anticoagulants prevent it from getting bigger.
They are mainly four different types:
- Vitamin K Antagonists: (Prevent blood clot by depleting active vitamin K molecules)
- Low molecular weight Heparin: ( Prevent clot formation by preventing actions of two of the clotting factors—Factor X and II)
- Direct Thrombin Inhibitors: Prevent action of thrombin (factor II) from converting fibrinogen into fibrin.
- Factor Xa Inhibitors: Block action of factor Xa, hence preventing clot formation.
Some of the common conditions requiring anticoagulation:
- Atrial fibrillation: (Irregularly irregular heart beat)
- Mechanical heart valve replacement:
- Mitral stenosis with atrial fibrillation
- Inherited thrombophilia and antiphospholipid syndrome (blood disorders)
- Post hip or knee surgery
- Deep vein thrombosis
- Heart attack
- Stroke
- Pulmonary embolism
- Stent thrombosis
- Deep vein thrombosis
Side Effects of Anticoagulants:
- Bleeding
- Abdominal pain
- Flatulence
- Headache
- Lethargy
- Dizziness
- Fever
- Nausea
- Anemia
- Ecchymosis ( easy bruising)
- Diarrhea
- Hair loss
- Rash
- Ithing
- Changes in sense of taste
- Fainting
- Shortness of breath
- Hypotension
- Chest pain
More serious side effects:
- Cholesterol embolus syndrome
- Intraocular hemorrhage
- Tissue necrosis
- Groin hemorrhage
- Hematuria
- Hepatitis
- Hypersensitivity reaction
- Hemorrhagic stroke
- Purple toe syndrome
- Increased risk for fractures
- Calciphylaxis
- Elevated aminotransferase level
- Thrombocytopenia
Caution and Contraindications for using anticoagulants
- Any head injury is advised to have a head CT scan, even if there are no symptom, to rule out intracranial bleed.
- User of anticoagulant must display the card or any other item given to them, mentioning their use of anticoagulation and the disease requiring it.
- Any injury can lead to excessive bleeding. Knowing about the use of anticoagulation, will help control the condition.
- Any surgical procedure, dental and orthodontic procedures etc. need to know about the use of anticoagulants, so that precautions can be taken.
Contraindications for anticoagulants:
- Stomach ulceration
- Hemorrhagic stroke
- Very high blood pressure
- Bleeding disorder
- Dissecting aorta
- Pericarditis
- Pericardial effusion
- Bacterial endocarditis
- Cerebral aneurysm
- Any active bleed
Monitoring of anticoagulation:
User of anticoagulants are advised to monitor anticoagulation by certain tests, like, INR, PT, and APTT, as recommended by their physicians.
Reference:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier
