There has been much debate between physicians about the need for heparin or a low-molecular-weight heparin (LMWH) use when initiating warfarin therapy for anticoagulation. The use of heparin or a LMWH when initiating warfarin therapy has been justified by a theoretical possibility of a transient hypercoaguable state from the warfarin use. Many physicians believe that the only safe and effective way to start a patient on warfarin is with the use of one of these heparins, however, the hypercoaguable state is just a theoretical possibility. Also, heparin bridging must be done in a hospital where the levels can be monitored, while a LMWH can be done at home, but is usually relatively expensive and requires the patient to give themselves injections. …show more content…
According to Zeuthen, Lassen, and Husted (2003), the theoretical possibility of a transient hypercoaguable state “emerges from a decline in plasma levels of protein C and S, at a time when factors X and II levels are still high due to a longer half life, [which] may lead to a transient hypercoaguable state within the first 12 to 60 hours” of warfarin initiation. In this study, 40 patients who had atrial fibrillation lasting longer than 48 hours were enrolled, and were randomized to receive either warfarin or a LMWH as antithrombotic treatment. Patients with ulcer disease, a gastrointestinal bleed within the past five weeks, uncontrolled hypertension, pregnancy, thrombocytopenia, renal insufficiency, or blood coagulation disorders were excluded (Zeuthen et al., 2003). The study specified that two patients dropped out voluntarily, 21 patients received LMWH and 17 patients received warfarin with a goal international normalized ratio (INR) in the range of 2.0 to 3.0. According to Zeuthen et al. (2003), the method of measuring the possibility of a hypercoaguable state involved assessing markers that reflected the protein and factor activity during the initiation of warfarin and the initiation of a LMWH. The patients in the study were randomly treated with warfarin or LMWH, as discussed previously, for three consecutive days, and biochemical markers were measured at …show more content…
Azoulay, Dell’Aniello, Simon, Renoux, and Suissa (2013) performed a post-hoc nested-control analysis using the United Kingdom’s clinical practice research datalink database of 70,766 patients aged 18 years and older, who were diagnosed with atrial fibrillation between 1993 and 2008. Patients with less than one year of medical history in the database, as well as patients with a history of mitral or aortic valve repair or replacement, or patients with a history of hyperthyroidism were excluded from the study. By using conditional logistic regression, Azoulay et al. (2013) was able to determine that there was a 71% increase of stroke during the first 30 days of warfarin treatment, with a decreased risk after the first 30 days. Azoulay et al. (2013) goes on to conclude that warfarin-naïve patients (patients who have never taken warfarin previously) with atrial fibrillation might have a greater increased risk for thrombotic events during the first 30 days of warfarin initiation. Therefore, the study concluded that the increased clotting risk may be due to a warfarin induced hypercoaguable state, or it may be due to the extended time interval it takes for a therapeutic INR to be achieved by inexperienced warfarin
Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed
Picturing the Bible, by Spier J. Kimbell Art Museum, Fort Worth, 2007. 288 pages. Reviewed by June Cuffner.
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
The period entered for the search was from January 2002 to August 2015. The Search terms were: “dual antiplatelet therapy”, “shortened DAPT”,”, “clopidogrel”, “early discontinuation”, “Drug-eluting stenting in diabetes mellitus AND Dual Antiplatelet Therapy”, “extended DAPT”, “prolonged DAPT”, “gastroenteritis AND clopidogrel”, “Delayed eosinophilic gastroenteritis and gastroenteritis”, “thienopyridine”, “P2Y12”, “premature cessation “drug eluting stents AND diabetes” , “duration of dual antiplatelet therapy”. The search had to be modified to include patient’s co-morbidities, medications and medical condition. The search initially started with optimal duration of dual antiplatelet therapy in patients after drug-eluting stent revascularization, and then the search was broadened to include diabetic patients with drug-eluting stent. Lastly I included gastroenteritis to unearth any relation between clopidogrel and Mrs GL’s hospital admittance.
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).
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.
However, 32 patients (42.1%) were using Warfarin prior to Dabigatran. The prior use of Warfarin was significantly associated with bleeding (p= 0.014), hospitalization (p< 0.001) , and death (p= 0.007). This was more prominent in older patients > 75 years, and in patients with comorbid conditions. The rate of hospitalization in the cohort for fifty one patients was (67.1%). There were no significant associations between hospitalization, and the tested variables. The levels of hemoglobin (taken as mean of 3 values) ≥130 versus 65 years. The causes of death in patients using Dabigatran were not relevant to the drug as per the death certificates (p <0.611), [Table 3]. The reported causes of death were attributed to TE, cardiac, and respiratory arrests. The only variables that were significantly associated with death were TE [p= 0.024, (95% CI for B= 0.44 - 0.586)], and blood transfusion [p= 0.011, (95% CI for B=0.085 - 0.639];
Annie Coffey is a 72 year old woman that has developed a deep vein thrombosis (DVT) due to reduced mobility while on bed rest. This assignment will discuss the signs, symptoms, prevention and management of a DVT and the use of warfarin as long term treatment. The assignment will explain what a DVT is and discuss its potential implications. The nurse’s role in the prevention of DVTs will be discussed in detail as well as the nursing management of Annie. The importance of patient education will be highlighted throughout the assignment and important discharge advice while on warfarin will be explained.
For decades, Warfarin has remained the anticoagulant of choice for the prevention of cardiac thromboembolic disease in atrial fibrillation patients and in the treatment of deep vein thrombosis and pulmonary embolism. VKAs are clinically effective as an antithrombotic agent in Atrial Fibrillation, as dose adjusted warfarin has been proven to cut the risk of stroke by 64% (95% CI, 49%-74%) and all-cause death rate by 26% (95% CI, 3%-43%) [2]. In order to attain optimal anticoagulation effect of warfarin, frequent plasma level monitoring of International Normalized Ratio (INR) is required to maintain it in therapeutic range (INR 2-3) but maintaining the INR in therapeutic range is challenging and for many patients is achieved only approximately 55% of the time [3]. Thus, this finding counteracts the potential benefits of warfarin and increases its risks. A combination of factors like an inconvenience for patients and clinicians to use warfarin, large variability in plasma level of the drug affected by ethnicity and genetic polymorphism [4,5], interactions with various foods and drugs and the potential for serious hemorrhage e.g. Intracranial bleeding, have limited the widespread use of warfarin as an effective anticoagulant in nonvalvular atrial fibrillation (NVAF) [6]. Keeping in mind these facts about
Maureen shows clinical manifestations such as hypotension (BP 80 mmHg systolic), tachycardia (HR 120 bpm and irregular), tachypnea (Resps 28 bpm), SaO2 unreadable, capillary refill time >4secs, temp 36.5°C (core) indicating the signs of hypovolaemia (Perner & Backer, 2014, p. 614). With the reference of Mrs. Hardy’s medical condition, such as arthritic knees and atrial fibrillation (INR 2.7), she is under diclofenac Acid 50mgs PO BD and warfarin 2mgs PO mane respectively (Jordan, 2010, p. 567; Zacher, et al., 2008, p. 930). Diclofenac is a
The pharmacological intervention includes the use of low molecular weight heparin (LMWH) and low-dose unfractionated heparin (LDUH). A finding of the study suggests that there is a significant reduction of VTE (13%) using thrombo-prophylaxis than without using any thrombo-prophylaxis (27%) and the single use of LDUH decreases the case with 15% (McNamara, 2014, pp.645). Furthermore, the study elaborates the use of aspirin could be an intervention to minimize the VTE but there is a chance of gastrointestinal bleeding. Thus, aspirin and other antiplatelet drugs are less effective methods to reduce VTE. Moreover, the pharmacological method is not effective in certain case that is associated with bleeding disorder. Therefore, there is a need of non-pharmacological preventive
For many year’s patients with atrial fibrillation have been treated with anticoagulants such as Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and that is an irritant for some patients. In October 2010, the FDA approved a new generational anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011). Since this medication does not require close monitoring, some wonder if is it truly a better option or can more harm than good come from taking it. While the benefits of using dabigatran have shown significant improvement over warfarin, there are still risks associated with using dabigatran.
Warfarin can lead to severe bleeding risks which may lead to fatality. Those who are over the age of 65 may be more sensitive to warfarin. ( cite)
From 1997 to 2007 anticoagulants have been identified as one of the top five drug types associated with patient safety in the United States. There is a big concern with patient education and medication administration in the hospital. In the hospital common problems included lack of standardization for the naming, labeling, and packaging of the medications that cause confusion. Additionally, lack of communication during report from nurse to nurse, information regarding monitoring, dose and time is not well communicated causing high risk for thromboembolism. Although some patients carry their treatment home, majority of patients receive treatment at the hospital. From year 1997 to 2008 twenty deaths and injuries occurred due to misuse of anticoagulants and only two deaths or injuries were associated with long term use. For patient education the health care profession must emphasis the importance of understanding and labeling the right medication, especially for pediatric patients. Additionally, anticoagulation labs should be provided before and during treatment to reduce any complications.
Beowulf is the hero in the poem by the same name. Throughout the poem Beowulf faces three battles, with Grendel, with Grendel’s mother and a dragon. Beowulf is already a seasoned warrior when he encounters his first demon in the poem, and he only gains more experience as the story goes on. Beowulf faces monsters and politics throughout the story of self-preservation, revenge and learning. Though the three beasts have similarities, Beowulf’s attack and battle with each of them is different.