Bridging: Subtherapeutic Anticoagulation Therapy

Prevention of DVT is advised in many medical and surgical inpatients by using anticoagulants, graduated compression stockings or intermittent pneumatic compression devices, (also known as thromboembolic deterrent stockings). Anticoagulation is the usual treatment for DVT. As a rule, patients are put on a brief course, (less than a week), of Heparin treatment, while starting a 3 to 6 month course of Warfarin (or related Vitamin K

You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve. You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization. PTT is more properly written

Ms Chasten was correctly diagnosed and treated for an acute MI complicated by a V Fib cardiac arrest. Her CAD was treated with PTCA and her post MI EF by echo was 20%. She received a LifeVest to protect her while his physicians treated her with beta blockers and

43 percent of alarm conditions indicated non-critical, and “generally non-actionable,” events; 38 percent of alarm conditions indicated premature ventricular complexes (PVCs), which, since a landmark 1988 Cardiac Arrhythmic Suppression Trial (CAST) study, are no longer treated; and 3.6 percent of alarm

There are many people that suffer from venous thromboembolism. Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. This is the third most common cause of vascular death after a myocardial infarction, also known as a heart attack, and stroke. This article examines the possibility of either full or low intensity anticoagulation therapy versus aspirin. This was a randomized study that consisted of 3,396 individuals who have venous thromboembolism. These individuals either received rivaroxaban, which is an anticoagulant, or 100 mg of aspirin once a day. The individuals in this study completed 6-12 months of anticoagulation therapy and were eligible for inclusion in the study if they were 18 years of age or older. The

clotting in vessels. This makes the person more vulnerable if when cut for the blood flow to cease in

In an article published in JACC: Cardiovascular Interventions, Doctors Madan, Halvorsen, Di Mario, Tan, Westerhout, Cantor, Le May, and Borgia explored whether patients experienced greater risk of undergoing angiography after the administration of fibrinolytic therapy. They concluded that there was not a serious risk of bleeding or death if they receive angiography within four hours of undergoing fibrinolytic therapy (Madan et al., 2015). They also suggest that the patient be moved a center that can perform PCI within 2 hours after fibrinolysis. This article suggests that although fibrinolysis can be success a patient should receive PCI treatment.

Enoxaparin is a low molecular weight heparin used to prevent thrombosis, particularly post surgery. Enoxaparin binds to antithrombin III which is responsible for inhibiting coagulation by acting on factor Xa. Enoxaparin accelerates the activity of antithrombin III therefore preventing clot formation (McKenna & Lim, 2014 p766). When a blood vessel is damaged, platelets in circulating blood stick to the site of injury and release chemicals that attract more platelets causing aggregation. There are both intrinsic and extrinsic pathways causing thrombi to form to maintain a closed cardiovascular system (Hollar, 2017). Immobility increases risk of thrombus formation as the blood becomes stagnant with gravity and decreased

Atrial Fibrillation is one of the leading causes of death across the globe. (1) AF increases an individual’s risk of stroke by 4 to 6 times on average. (2)(3) The risk increases with age, in people older than 80 years old; AF is the straight cause of 1 in 4 strokes. (3) Even though Atrial Fibrillation can be considered a mild arrhythmia; it is still associated with serious morbidity and mortality. (4)(5) First, it raises the risk of having thromboembolism and stroke, due to blood stasis in the left atrium. Stroke is commonly caused by a thrombus or clot. In patients with AF, the thrombus or clot is usually comes from the left atrial appendage (a small sac in the left upper chamber of the heart). Because stroke in AF patients may be particularly distressing, it is quite important to identify patients who are possibly at high risk before it occurs to them. Second, the irregularly irregular heart beat can cause symptoms palpitations, shortness of breath, anxiety and reduced exercise tolerance in the patient, so it requires medical consideration. Third, Atrial Fibrillation causes a lot of cardiac and hemodynamic changes including decreased myocardial systolic function and cardiomyopathy caused by tachycardia. (6)(7) Sometimes AF is identified only with the onset of a stroke or a transient ischemic attack (TIA or "mini-stroke"). (8) Whether if it is asymptomatic or symptomatic, AF is a progressive disease, worsening with time and it is accounting for

Atrial fibrillation is the most commonly encountered arrhythmia (abnormal heart rhythm) in the United States, diagnosed in approximately 1% of the population or 2.5 million people (Nottingham, 2010). Atrial fibrillation has always been of interest during this author’s healthcare career. It is always out there, insidiously hiding, causes a multitude of symptoms and problems. This author remembers puzzling over the presentation of atrial fibrillation and it’s management. Identification is always the first challenge. Banner and Lauck (2013) cite Falk (2001) acknowledging the wide presentation of symptoms from asymptomatic to life threatening. Patient specific options can be confusing and challenging to navigate. Treatment algorithms include pharmacology, electrophysiological interventions, and surgery (Berry, Padgett, & Holton, 2015). This author believes, given the prevalence and consequences of mismanagement, the study of relevant evidence based practice in the treatment of atrial fibrillation is a worthy concentration. For many patients, nurses are the first point of contact in the healthcare system. This demands nursing leadership in the areas of identification, treatment and education for atrial fibrillation.

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Ideally, you would transport the patient to a PCL capable hospital; if not PCL capable, transfer patient as soon as possible and less than 120 minutes, if transfer is more than 120 minutes, give fiberinoly agent within 30 minutes of arrival. Get sent to the Cath lab, diagnostic angiogram, PCL (Percutaneous Coronary Intervention) if reclusion occurs of perfusion fails in a patient given a fibrinolytic, arrange transfer to a PCL capable facility. Early treatment for a heart attack can prevent or limit damage to the heart muscle. Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include: oxygen therapy, Aspirin to thin your blood clotting, Nitroglycerin to reduce your

The risk of embolism did not differ between tissue and mechanical valves for either the aortic or mitral valve recipients.” (S. Khan el at, 2001).The main difference between mechanical and tissue are outcomes seen between these valve types are patient at higher risk of getting hemorrhage in the aortic mechanical valve and a patient have higher risk of getting structural failure in all tissue valve replacement. “As both valve complications between tissue and mechanical valves is logical and follows from the progressively increasing rate of tissue valve reoperation balanced against a constant higher risk of hemorrhage in the mechanical valve recipients. The later crossover point of aortic valve recipients compared with that of mitral valve recipients is consistent with the higher rate of mitral valve recipient reoperation” (S. Khan el at,

A mild arrhythmia may require no treatment, though your doctor will want to monitor the condition periodically to make sure it doesn't worsen. When treatment is given, it is usually in the form of drugs, surgery, or one of many nonsurgical procedures. Medications include blood thinners (warfarin or heparin) to prevent clotting, along with beta blockers and calcium channel blockers. These latter two classes of medications are given to slow the patient's heart rhythm; they are often used to treat a-fib or v-fib.

Atrial fibrillation is a common chronic condition, occurring in approximately three million people in the United States (American College of Cardiology, 2015). It can lead to serious complications such as blood clots, stroke, or heart failure (American College of Cardiology, 2015). Therefore, healthcare providers must understand how to manage new onset and chronic atrial fibrillation.