Anticoagulants adverse reactions

Discuss ways to promote an optimal response to therapy, how to manage common adverse reactions, and important points to keep in mind when educating patients about the use of an anticoagulant or thrombolytic drug. 

The LMWHs cause fewer adverse reactions tiian heparin. Bleeding related to die LMWHs is possible but has generally been low. See die Summary Drug Table Anticoagulants for additional adverse reactions associated widi die LMWHs. 

The principal adverse reaction to warfarin is hemorrhage. Prolonged therapy with the coumarin-type anticoagulants is relatively free of untoward effects. Bleeding may be observable (e.g., skin, mucous membranes) or occult (e.g., gastrointestinal, renal, cerebral, hepatic, uterine, or pulmonary). Rarer untoward effects include diarrhea, small intestine necrosis, urticaria, alopecia, skin necrosis, purple toes, and dermatitis. 

Soybean oil is widely used intramuscularly as a drug vehicle or as a component of emulsions used in parenteral nutrition regimens it is also consumed as an edible oil. Generally, soybean oil is regarded as an essentially nontoxic and nonirritant material. However, serious adverse reactions to soybean oil emulsions administered parenterally have been reported. These include cases of hypersensitivity, CNS reactions, " and fat embolism. " Interference with the anticoagulant effect of warfarin has also been reported. ... 

Gallerani M, Manfredini R, Moratelli S. Non-haemorrhagic adverse reactions of oral anticoagulant therapy. Int J Cardiol 1995 49 1-7. 

Besides alcohol, some cephalosporins (cefamandole, cefimetazole, cefopera-zone, or cefotetan) expose the patient to an increased risk of hemorrhaging if administered with anticoagulants such as coumarin or indanedione, heparin, and with clot-busting drugs such as thrombol5 cs. The same adverse reaction might occur if the patient takes NSAlDs, especially aspirin, or sulfinpyrazone (Anturane) while on cephalosporins. 

It is important to note that an accurate economic model of this problem is impossible to construct. Adverse events are not caused by unusual or rare circumstances (Johnson and Bootman, 1997). Rather, these events make up a familiar list, including wound infections, drug overdoses, administration of the wrong drugs, bleeding from anticoagulation, insulin reactions, missed diagnoses, and falls. Because these risks and events are known and predictable, they are also preventable. It is estimated that these preventable events represent 69.6 percent of medical accidents (Leape and others, 1993). 

Dobutamine stress echocardiography is a generally well-tolerated study to evaluate patients with suspected coronary artery disease. Rare but life-threatening complications of this study have been well described. Severe hypertensive responses are a known but uncommon adverse reaction to dobutamine infusion. A case of intracranial haemorrhage in the setting of severe hypertension as a complication of dobutamine stress echocardiography was reported. The patient was on systemic anticoagulation with warfarin for a prosthetic mitral valve and had... 

Warfarin is the most commonly prescribed oral anticoagulant, with four million U.S. patients taking the drug for treatment and prevention of atrial fibrillation, stroke, deep vein thrombosis, or pulmonary embolism, and for those who have had heart valve replacement surgery. Adverse reactions to warfarin... 

Despite this, especially in the last few years, research in this area has increased, based either on approaches previously found promising or on structural features now felt to be capable of reducing adverse reactions. Broadly classified, these recent and current approaches are in the areas of bulk polymers and copolymers, surface modifications, and modifications of mechanical properties or the use (or nonuse) of fillers. Other approaches to blood compatible materials such as treated umbilical veins and porcine heart valves or the use of polymers as reservoirs for the release of anticoagulants or platelet protective agents are not included in this discussion. Also, the review of these approaches is not intended to be exhaustive, but to summarize representative ongoing research in this field. 

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