Warfarin Therapy Research Paper

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

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

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.

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

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.

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.

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

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)

The dabigatran etexilate (DE) is a prodrug that directly competes for the active site of thrombin.1 This direct inhibition inactivates both fibrin-bound and free form of thrombin. Because of its rapid onset and offset of action, there is no need for the initial parenteral anticoagulant treatment in patients with acute thrombosis.1 On the other hand, the enoxaparin indirectly inhibits factor Xa.2 It has a shorter duration of action (12h vs 24h) and a shorter half-life (4.5-7h vs 12-14h) in comparison to DE. The DE and the enoxaparin have no interaction with diet and alcohol. There is no routine monitoring required

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).

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.

• Taking too much or too little warfarin is dangerous. Too much warfarin increases the risk of bleeding. Too little warfarin continues to allow the risk for blood clots. While taking warfarin, you will need to have regular blood tests to measure your blood clotting time. A PT blood test measures how long it takes for blood to clot. Your PT is used to calculate another value called an INR. Your PT and INR help your health care provider to adjust your dose of warfarin. The dose can change for many reasons. It is critically important that you take warfarin exactly as prescribed.

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];

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

2. Gordon H. Guyatt, Elie A. Akl, Mark Crowther, David D. Gutterman, Holger J. Schuunemann. Antithrombotic Therapy and Prevention of Thrombosis. American College of Chest Physician Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141. 3. Neil J. Stone, Jennifer G. Robinson, Alice H. Lichtenstein, C. Noel Bairey Merz, Conrad B. Blum, Robert H. Eckel, Anne C. Goldberg, David Gordon, Daniel Levy, Donald M. Lloyd-Jones, Patrick McBride, J. Sanford Schwartz, Susan T. Shero, Sidney C. Smith Jr, Karol Watson, Peter W. F. Wilson. Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in