A Research Study On Anticoagulant Activity

As our population ages, patients are living longer as a result of advances in medical technology, surgical procedures, and drug development(Bressler MD & Bahl PhD, 2003). The average older person is taking two to five prescription medications daily and one in five of this age group has a medication related hospitalization annually (McLean & LeCouteur, 2004). In my eighteen years of nursing, I have taken care of many patients being treated with anticoagulant medications for various reasons, and I have found that most of these patients are not educated about the risks, benefits, and adverse reactions associated with anticoagulants.

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Administering anticoagulants is a major problem in the healthcare field. According to Monagle, Studdert, and Newall (2012), “Heparin is one of the most commonly used drugs in tertiary pediatric centres […and] a plethora of fatal and non-fatal heparin-related errors [are] being reported ” (p. 1). A specific incident occurred in 2007 regarding a medication error that affected the two infant twin boys of Dennis and Kimberly Quaid. Shortly after birth, the twins developed a staph infection and were to be given an anticoagulant called hep-lock. According to Rick Shapiro with The Legal Examiner, “the nurses administered at least two doses of heparin”(Shapiro, 2010, p. 1). Heparin is a more potent medication than hep-lock. This mistake meant

The usage of anticoagulant therapy is one of the most common forms of medical intervention. The CHADS2 score is the simplest and most commonly used stroke- risk assessment tool since its implementation 2001. This scale is used to determine whether or not anticoagulation therapy is required for patients with episodic atrial fib. A higher CHADS2 score is directly related to a greater risk of stroke. The level of risk from a thrombotic event is determined by a score which is tallied by including five common stroke risk factors; congestive heart failure, hypertension, age, diabetes, and history of stroke. If a patient is positive for any of these risk factors they receive one point with the history of stroke getting 2 points (Camm et al, 2010).

Managed Anticoagulation Care (MAC) will target geriatric patients with heart disease who are on anticoagulants. This project will be successful by upholding our vision through providing reliable services, cost effectiveness, accessibility and bilingual staff members to serve the Hispanic community. The primary focus of MAC is to provide a focused and personalized treatment and education of the heart and vascular diseases. Though all patients are welcome to this clinic, however our two target populations will be Hispanic and elderly (65 years and older) population. According to the Texas Department of State Health Services, the leading cause of death in Texas is the heart disease, accounted for 23.5%. It is very essential to start this clinic to provide the best patient care, improve the quality of life, and decrease emergency visits by anticoagulation patients.

(Karmiova, 2001) and is predictive of subsequent multiple organ failure, infection and than eventually death in these patients. These conditions have many features common with sepsis. Blood concentrations of various cytokines, soluble receptors and endotoxins increase within as early as 3 hours after cardiac arrest, the magnitude of these changes is associated with the outcome. Activation of blood coagulation without adequate activation of endogenous fibrinolysis is an important pathophysiological mechanism that may contribute to microcirculatory reperfusion disorders (Böttiger, 1995). For patients that undergo CPR and achieve ROSC, their coagulation/anticoagulation and fibrinolysis/antifibrinolsis systems are activated. Anticoagulant factors such as antithrombin, protein S and protein C are decreased and this decrease is associated with transient increases in endogenous activated protein C after resuscitation (Adrie,2005). The stress of total-body oxygen debt also affects adrenal production and function. Although patients have increased plasma cortisol levels they have a relative adrenal insufficiency defined as failure to respond to corticotrophin. This failure to respond causes the adrenal cortex to not be stimulated to secrete the hormones necessary to respond to stress.

Admission assessments are important tools in providing culturally-competent care. Not only does a health care provider gain important health information, but also cultural considerations to follow during health events. Cultures such as Jehovah’s Witnesses and Christian Scientists immediately alert healthcare providers to possible interruptions in care due to cultural restrictions regarding blood transfusions and medical interventions. The Jewish population however, doesn’t put providers on high alert, though in certain incidents it should. When one reflects on the Kosher guidelines, avoidance of pork is a given, but pork isn’t present in food alone, porcine is found in medicines and medical implants. The medication classes span from anticoagulants to natural supplements and medications containing gelatin (Queensland, 2013).

Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic and hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximize the safety of anticoagulation in the elderly, factors like comorbidities and co-medication, pharmacokinetic and pharmacodynamics alteration due to renal and hepatic function associated with aging, consequences due to insufficient education, need to be considered (109-111).The European society of cardiology- working group on thrombosis recommend considering all of the

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Anticoagulant treatment for deep-vein thrombosis aims to prevent pulmonary embolism and recurrent thrombosis and also to avoid excessive bleeding. In addition, both the effect of therapy on the patients’ well-being and the cost of therapy are factors to be weighed in determining the optimal treatment. It is current practice to treat acute venous thrombosis with intravenous standard (unfractionated) heparin for at least five days in a dose adjusted to lengthen the activated partial-thromboplastin time into a desired range. Oral anticoagulant therapy is started concomitantly and continued for at least three months. This approach is effective, but it suffers from the limitation that patients need to be admitted to the hospital, where intravenous

Hello Flo, I agree on the great information you provide on warfarin. Accordingly, working on a surgical unit, we deal with patient on coumadin on the daily basis. Education are provided to these patient before and after surgery. Consequently, there are patients that arrive for surgery with elevated INR, which the physician will treat or cancel the surgery. Physician normally have patient to discontinue coumadin three to five days prior to surgery, to prevent excessive bleeding. " The management of anticoagulation in patients undergoing surgical procedures is challenging because interrupting anticoagulation for a procedure transiently increases the risk of thromboembolism. At the same time, surgery and invasive procedures have associated bleeding

Warfarin and novel anticoagulants are increasingly utilized for the prevention of clotting in various increased risk disease states or anatomic changes including atrial fibrillation, the presence of artificial heart valves, and development of repeated deep venous thromboses (1-3). While the potential benefits of anticoagulation are useful, the risk of hemorrhage increases significantly (4). The incidence of major bleeding has been estimated at 1–3% annually and is even greater when the international normalized ratio (INR) is greater than 4.5 (4). Coinciding with the increased utilization of anticoagulant medications is the increasing incidence of emergency general surgery (EGS) disease such as acute cholecystitis, peptic ulcer

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