American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
-
To describe the mechanisms of action, pharmacokinetics, and rate of bleeding complications from warfarin and target-specific oral anticoagulants; methods for assessing the risk for thromboembolism and bleeding in patients receiving oral anticoagulants or temporarily interrupting such therapy to undergo elective invasive procedures or surgery; therapeutic strategies for balancing these risks; and coagulation assays used to monitor oral anticoagulation therapy. ⋯ An individualized approach is needed to balance the risks for thromboembolism and bleeding in patients receiving oral anticoagulants.
-
Am J Health Syst Pharm · May 2013
Pharmacologic interventions for reversing the effects of oral anticoagulants.
To describe the pharmacologic agents and strategies used for urgent reversal of warfarin and the target-specific oral anticoagulants dabigatran, rivaroxaban, and apixaban. ⋯ Phytonadione and clotting factor concentrates appear to have a role for reversal of warfarin, and limited evidence suggests that clotting factor concentrates could have a role in reversal of target-specific oral anticoagulants in an emergency situation.
-
To describe a process for prompt evaluation and management- including reversal of the effects of warfarin and target-specific oral anticoagulants-of patients with or at high risk for bleeding during oral anticoagulant therapy or when such therapy is interrupted for an urgent invasive procedure or surgery. ⋯ A comprehensive plan individualized to each agent should be developed to promptly reverse the effects of oral anticoagulants and optimize outcomes in patients with bleeding or an urgent need for surgery.
-
Am J Health Syst Pharm · May 2013
ReviewUse of antiepileptics for seizure prophylaxis after traumatic brain injury.
Antiepileptics used for seizure prophylaxis after traumatic brain injury (TBI) are reviewed. ⋯ The available literature supports the use of antiepileptics for early PTS prophylaxis during the first week after a TBI. Phenytoin has been extensively studied for this indication and is recommended by the AAN and Brain Trauma Foundation guidelines for early PTS prophylaxis. Levetiracetam has demonstrated comparable efficacy to phenytoin for early PTS prophylaxis and may be a reasonable alternative to consider in this patient population.