Stay up-to-date on anticoagulants
AnneMarie Palatnik MSN, APN, ACNS-BC

Nursing2014 Critical Care
November 2012 
Volume 7  Number 6
Pages 16 - 20
  PDF Version Available!

Anticoagulation therapy can be used to prevent or treat a variety of conditions, from venous thromboembolism (VTE) to atrial fibrillation (AF), ischemic stroke, and acute coronary syndromes (ACS). The challenges are in understanding all of the different anticoagulants, which ones to use when, and how to keep patients safe during anticoagulant therapy. The ultimate goal is to prevent thrombi while minimizing the risk of bleeding.Our current drugs, while effective, are difficult to manage. Vitamin K antagonists (VKAs) have a narrow therapeutic window requiring frequent monitoring, a delayed onset of action, and many food and drug interactions. Low-molecular-weight heparins (LMWHs) are affected by the patient's renal clearance. And among other challenges, unfractionated heparin (UFH) has a nonlinear dose-response curve; that is, the therapeutic levels in patients receiving UFH aren't always related to their dose of heparin or their activated partial thromboplastin time.The ideal anticoagulant should be safe and effective; have a linear dose-response curve; have a wide therapeutic range; be a single daily dose (preferably oral); have rapid onset of action; require little or no monitoring; have no food or drug interactions; have limited renal elimination; have an appropriate antidote; be synthetic (eliminating the variability found in anticoagulants produced from animal products); and have a reasonable cost.1To understand how anticoagulants work, you need to review how a thrombus is formed. Two simultaneous processes are at work here: the coagulation cascade and platelet activity.Vessel injury triggers the release of tissue factor, which stimulates the coagulation cascade and converts prothrombin to thrombin. Thrombin, acting as an enzyme, converts fibrinogen to fibrin (the material that stabilizes the clot).At the same time that blood coagulation is occurring, platelets are being exposed to a variety of subendothelial proteins, such as collagen, adenosine diphosphate (ADP),

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