Anticoagulants are used to reduce the ability of the body to form blood clots. If clots have already been formed, anticoagulants will not dissolve them, but may keep the clots from getting bigger. Anticoagulants work by keeping the liver from producing vitamin K. This affects the way in which platelets work in making the blood clot. An aspirin is one example of a simple anticoagulant that some people take daily to prevent heart attacks or strokes.
Although it is well-settled that anticoagulants can be life-saving medications, a person who is taking them is also subject to a high risk of harm. Since the ability of the blood to clot is reduced, there is a risk that those who are taking anticoagulants will have an episode of increased bleeding. The bleeding can range from a nosebleed that is easily controlled to a brain bleed that results in death.
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Conditions for Which Anticoagulants Are Prescribed
Conditions for which anticoagulants are often prescribed include:
- Arterial Fibrillation (AF): which is an irregular heartbeat that affects the flow of blood to and from the heart.
- Artificial heart valve: This replaces one of the four heart valves and requires anticoagulation therapy to prevent blood clots and subsequent strokes.
- Deep Vein Thrombosis (DVT): This is a blood clot in a deep vein, usually in the legs. It may cause pain and swelling. It occurs more often in immobile people particularly those who may be confined to their beds in a nursing home.
- Pulmonary embolism (PE): A pulmonary embolism is a blockage of blood flow in a pulmonary artery, most likely from a blood clot that traveled to the lung from the leg.
- Prevention of blood clots: Anticoagulants are often used after surgery to prevent blood clots that may form when a patient is idle for a period of time.
- Stroke: Strokes are often caused by blood clots to the brain and, for years, anticoagulation therapy was considered the primary treatment. Whether to use anticoagulants after a stroke is decided on a case by case basis.
- Heart attack: Anticoagulants are given to prevent blood clots from causing another heart attack.
Depending on the reason for the therapy, anticoagulants may be prescribed for a limited period of time or for life.
Importance of Anticoagulation Therapy Monitoring
Each case is different and there is no one-size-fits-all dosage. Blood tests are initially conducted to determine a person’s therapeutic range. After that, periodic blood tests are generally prescribed to monitor the time it takes for the blood to clot. The doctor will adjust the medication dosage depending on the results of the blood tests.
Risk Factors and Contraindications for Anticoagulation Therapy
There are some risk factors and consequences of anticoagulation therapy of which every patient undergoing this therapy needs to be aware. Excessive medication doses may lead the patient to suffer a severe and life-threatening bleeding episode. Not enough medication may lead to strokes, deep vein thrombosis, pulmonary embolism or other complications of blood clots. Some things patients can do to reduce their risk include:
- Reporting to their doctor any incident of excessive bruising or bleeding from a cut or nosebleed.
- Seeking medical attention if they suffer a head injury of any kind. The risk of bleeding is great.
- Reporting to their physicians if they have prolonged bleeding from brushing their teeth or if they notice what appears to be blood in their urine or stools or cough up or vomit blood.
- Pregnant women should avoid certain anticoagulant therapy medications which are known to cause malformation in the fetus. They should actually discuss the medications with their doctor prior to becoming pregnant if possible.
- Patients should be sure their dentist knows they are on anticoagulant therapy before undergoing any dental procedure.
- Patients should make sure all health care professionals are aware of the anticoagulant therapy before any other medical or surgical procedures are performed.
- No other medications should be taken, not even over-the-counter ones, without the physician and pharmacist being totally aware of all medications and giving the anticoagulant therapy patient an okay. Even what seems like a simple cold medicine may cause disastrous effects if combined with an anticoagulant.,
- Patients should wear a medical alert warning that includes the information that they are taking anticoagulants.
Dangers of Anticoagulant Therapy May Lead to Medical Malpractice
Patients who are performing perfectly well may face untoward effects if they need a surgical procedure and the surgeon is unaware the patient is on anticoagulant therapy and under the care of a different physician. When a patient suffers an unexpected result from a medical or surgical procedure, such as a heart attack, stroke or massive bleed, some errors health care professionals have made that have led to medical malpractice lawsuits include, but are not limited to:
- Failure to obtain a complete medical history of the patient so the procedure was performed without the knowledge that the patient was on anticoagulant therapy.
- Failure to properly monitor the anticoagulant therapy, resulting in the patient taking too much or not enough medication resulting in tragic results.
- Inadequate education of the nursing staff of the importance of reporting bleeding time levels to the physician.
- Failure of nursing staff to administer the anticoagulant dosage at the correct time.
- Overall improper management of the anticoagulant therapy during a hospitalization.
- Failure to properly instruct the patient on the risks and on what to watch for indicating on over or under medication dose.
- Improper or inadequate documentation of the patient’s medical or surgical procedure and medications.
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