American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Jun 2013
Development and implementation of a nurse-driven, sliding-scale nomogram for bivalirudin in the management of heparin-induced thrombocytopenia.
A simplified dosing nomogram to assist nurses in adjusting the rate of i.v. bivalirudin administration in cases of heparin-induced thrombocytopenia (HIT) is described. ⋯ A nurse-driven, sliding-scale nomogram for bivalirudin therapy in patients with HIT provided a simple dosing protocol and resulted in a high rate of adherence by nurses.
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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.
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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.
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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.