anticoagulative

Patient Care. The major difficulties that may arise during the course of anticoagulant therapy are hemorrhage and drug interaction. Observation of the patient for early signs of internal as well as external spontaneous bleeding is of primary importance. Health care personnel responsible for the care of these patients must be knowledgeable about the various laboratory tests and interpretation of their results in the administration of anticoagulant drugs and in assessment of the patient.

The effects of anticoagulants can be enhanced or inhibited by a variety of drugs and chemical compounds, especially the salicylates, barbiturates, and antibiotics. Ambulatory patients must be cautioned against taking any other drugs in combination with an anticoagulant agent without first consulting with the health care provider who prescribed the drug. This includes nonprescription or “over-the-counter” drugs as well as prescription drugs. Dietary restrictions such as fasting diets or those that limit the intake or utilization of the fat-soluble vitamin K can result in increased pharmacologic action of an anticoagulant.

The patient and family should be given adequate instruction in the purposes of anticoagulant therapy, the effects and side effects of other drugs and dietary intake on anticoagulant agents, and the need for regular contact with members of the health care team so that adequate monitoring of the patient's status can be continued as long as the patient is receiving an anticoagulant.

Instruction of the patient and significant others should include prevention of accidental injury, basic first aid measures to control bleeding should an accident occur, the danger signs that warrant immediate medical attention, and assurance that bleeding can be controlled. A Medic Alert bracelet should be worn to alert health care professionals in an emergency situation that the patient is taking anticoagulants.

Women of childbearing age need counseling about the effects of anticoagulants on contraceptive methods and reproduction. Those who are taking an anticoagulant for prevention of emboli cannot use oral contraceptives or an intrauterine device, which could cause endometrial bleeding. Should a patient think she is or desires to be pregnant, the primary care provider should be notified at once. Warfarin crosses the placental barrier and can cause fatal hemorrhage in the fetus. It can also enter the mother's milk and have an anticoagulant effect in the nursing baby. Heparin does not have these properties and can be substituted for warfarin when necessary.