Anticoagulationrelated

Anticoagulation-related refers to issues surrounding the use of medicines that inhibit blood clot formation. Anticoagulants are prescribed to prevent thrombosis in conditions such as atrial fibrillation, venous thromboembolism, and in patients with mechanical heart valves. The main classes include vitamin K antagonists (for example warfarin), direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban, and parenteral agents like heparin and enoxaparin.

Dosing and monitoring vary by agent. Warfarin requires regular INR monitoring with dose adjustments. DOACs provide fixed dosing in most patients but require assessment of kidney function and potential drug interactions. Parenteral anticoagulants are often used in hospital settings or as a bridge therapy around procedures.

Bleeding is the principal anticoagulation risk. Management depends on severity and agent, including holding treatment, local hemostatic measures, and reversal strategies. Reversal options include vitamin K and prothrombin complex concentrates for warfarin; idarucizumab for dabigatran; andexanet alfa for factor Xa inhibitors; PCCs may be used in certain scenarios.

Monitoring and safety: Regular assessment of renal function, hepatic function, and potential drug interactions is important. Scores such as CHADS-VASc guide stroke risk, while HAS-BLED estimates bleeding risk. Patient education on signs of bleeding, dosing timing, adherence, and avoiding unapproved supplements is essential.

Perioperative and special situations: Planning around procedures involves timing interruptions and possible bridging with heparin in select patients. Restarting anticoagulation after procedures balances thrombosis and bleeding risk. Pregnancy, elderly status, and organ dysfunction may affect choice and dosing.

Guidelines and research: Professional bodies provide recommendations on agent choice, monitoring, reversal, and perioperative management.