Anticoagulants, drug reaction

Some examples of this approach are the linkage of adverse outcomes of inappropriate anticoagulation (stroke, myocardial infarct, or death widiin 6 days) to the measurement of prothrombin times and the linkage of adverse effects of digoxin therapy (death or hospitalization caused by insufficiency, overdose, or drug reaction) with the measurement of digoxmd ... 

The oral anticoagulant drugs act indirectly on the process of Glu carboxylation of the vitamin K-dependent proteins. The vitamin K antagonists prevent the reduction of the reaction intermediate, vitamin K epoxide. Blockage of the epoxide reductase reaction results in the accumulation of vitamin K epoxide and other nonfunctional forms of vitamin K. Without regeneration of the vitamin K-related reaction intermediates through the cycle shown in Figure 36-22, a depletion of functional vitamin K occurs. 

However, there are two discordant reports. A patient stabilised on dicou-maroi developed multiple ecchymoses and a prothrombin time of 53 seconds within 2 weeks of starting to take diazepam 5 mg four times daily. The New Zealand Committee on Adverse Drug Reactions has received one report of an increased anticoagulant effect in a patient taking warfarin with diazepam. It is by no means certain that these responses were due to an interaction. 

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). 

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. 

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