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Managing Complications of Anticoagulant Therapy

Department of Pharmacy Practice, Wayne State University, Detroit, Michigan, William Beaumont Hospital, Royal Oak, Michigan, msmythe{at}beaumont.edu

William E. Dager, PharmD

University of California, Davis, Medical Center, University of California, San Francisco, School of Pharmacy

Nima M. Patel, PharmD, BCPS

Temple University School of Pharmacy, Philadelphia, Pennsylvania

Understanding the frequency, risk factors, and management of anticoagulant-induced adverse events will assist clinicians in optimizing patient outcomes. The most frequent adverse event of all anticoagulants is major bleeding. Risk factors for major bleeding have been identified with the heparin compounds, the direct thrombin inhibitors (DTIs), fondaparinux, and warfarin therapy. Understanding these risk factors can help prevent bleeding events. For cases of clinically significant bleeding, reversal agents exist primarily for heparin and warfarin. Although less common, nonbleeding adverse events of anticoagulant therapy can also be life threatening. The heparin compounds are associated with the development of heparin-induced thrombocytopenia (HIT) and osteoporosis. HIT can result in life-threatening thrombosis and is usually managed with a DTI. Nonbleeding adverse events with warfarin therapy include skin reactions and the development of venous limb gangrene. Appropriate initiation of warfarin therapy may decrease the risk of venous limb gangrene.

Key Words: Anticoagulation • heparin • warfarin • INR • aPTT • ACT

Journal of Pharmacy Practice, Vol. 17, No. 5, 327-346 (2004)
DOI: 10.1177/0897190004271776


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