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Anticoagulation drug therapy: a review.

Harter K, Levine M, Henderson SO - West J Emerg Med (2015)

Bottom Line: Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants.Consequently, the emergency physician should be familiar with the newer and older anticoagulants.This review emphasizes the indication, mechanism of action, adverse effects, and potential reversal strategies for various anticoagulants that the emergency physician will likely encounter.

View Article: PubMed Central - PubMed

Affiliation: University of Southern California, LA+USC Medical Center, Department of Emergency Medicine, Los Angeles, California.

ABSTRACT
Historically, most patients who required parenteral anticoagulation received heparin, whereas those patients requiring oral anticoagulation received warfarin. Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants. Consequently, in recent years many novel anticoagulants have been developed. The emergency physician may institute anticoagulation therapy in the short term (e.g. heparin) for a patient being admitted, or may start a novel anticoagulation for a patient being discharged. Similarly, a patient on a novel anticoagulant may present to the emergency department due to a hemorrhagic complication. Consequently, the emergency physician should be familiar with the newer and older anticoagulants. This review emphasizes the indication, mechanism of action, adverse effects, and potential reversal strategies for various anticoagulants that the emergency physician will likely encounter.

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Related in: MedlinePlus

Comparison table for anticoagulants.9,19,25,38PT, pro-thrombin time; INR, international normalized ratio; HIT, heparin-induced thrombocytopenia; PO, oral administration; IV, intravenous; FFP, fresh frozen plasma; aPTT, activated partial thromboplastin time; UFH, unfractionated heparin; PCC, prothrombin complex concentrates
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f3-wjem-16-11: Comparison table for anticoagulants.9,19,25,38PT, pro-thrombin time; INR, international normalized ratio; HIT, heparin-induced thrombocytopenia; PO, oral administration; IV, intravenous; FFP, fresh frozen plasma; aPTT, activated partial thromboplastin time; UFH, unfractionated heparin; PCC, prothrombin complex concentrates

Mentions: As NACs become more pervasive in the clinical setting, used for both therapeutic and prophylactic purposes, it will become essential for the emergency physician to become aware of the indications to start specific drugs, as well as unique complications and recommended reversal methods for such agents. An intimate knowledge of these drugs will be required for the ideal management. Unfortunately, while the clinical efficacy of NACs has been established, much less is known about the risks of adverse reactions as well as the ability to reverse these agents.6Figure 3 below summarizes the most widely-used anticoagulants; they will be discussed in this article. This article provides a review of the literature as it focuses on both the risks associated with anticoagulants, as well as reversal agents of the most commonly used NACs to help guide management in the emergency setting.


Anticoagulation drug therapy: a review.

Harter K, Levine M, Henderson SO - West J Emerg Med (2015)

Comparison table for anticoagulants.9,19,25,38PT, pro-thrombin time; INR, international normalized ratio; HIT, heparin-induced thrombocytopenia; PO, oral administration; IV, intravenous; FFP, fresh frozen plasma; aPTT, activated partial thromboplastin time; UFH, unfractionated heparin; PCC, prothrombin complex concentrates
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307693&req=5

f3-wjem-16-11: Comparison table for anticoagulants.9,19,25,38PT, pro-thrombin time; INR, international normalized ratio; HIT, heparin-induced thrombocytopenia; PO, oral administration; IV, intravenous; FFP, fresh frozen plasma; aPTT, activated partial thromboplastin time; UFH, unfractionated heparin; PCC, prothrombin complex concentrates
Mentions: As NACs become more pervasive in the clinical setting, used for both therapeutic and prophylactic purposes, it will become essential for the emergency physician to become aware of the indications to start specific drugs, as well as unique complications and recommended reversal methods for such agents. An intimate knowledge of these drugs will be required for the ideal management. Unfortunately, while the clinical efficacy of NACs has been established, much less is known about the risks of adverse reactions as well as the ability to reverse these agents.6Figure 3 below summarizes the most widely-used anticoagulants; they will be discussed in this article. This article provides a review of the literature as it focuses on both the risks associated with anticoagulants, as well as reversal agents of the most commonly used NACs to help guide management in the emergency setting.

Bottom Line: Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants.Consequently, the emergency physician should be familiar with the newer and older anticoagulants.This review emphasizes the indication, mechanism of action, adverse effects, and potential reversal strategies for various anticoagulants that the emergency physician will likely encounter.

View Article: PubMed Central - PubMed

Affiliation: University of Southern California, LA+USC Medical Center, Department of Emergency Medicine, Los Angeles, California.

ABSTRACT
Historically, most patients who required parenteral anticoagulation received heparin, whereas those patients requiring oral anticoagulation received warfarin. Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants. Consequently, in recent years many novel anticoagulants have been developed. The emergency physician may institute anticoagulation therapy in the short term (e.g. heparin) for a patient being admitted, or may start a novel anticoagulation for a patient being discharged. Similarly, a patient on a novel anticoagulant may present to the emergency department due to a hemorrhagic complication. Consequently, the emergency physician should be familiar with the newer and older anticoagulants. This review emphasizes the indication, mechanism of action, adverse effects, and potential reversal strategies for various anticoagulants that the emergency physician will likely encounter.

Show MeSH
Related in: MedlinePlus