Anticoagulants, history

Anticoagulants History of local radiotherapy History of Keloid formation Pregnancy/breast-feeding Heavy smokers... 

The incidence of HIT is lower with LMWHs than with UFH. However, LMWHs cross-react with heparin antibodies in vitro and should not be given as an alternative anticoagulant in patients with a diagnosis or history of HIT.5 Monitor platelet counts every few days during the first 2 weeks and periodically thereafter.5... 

The analgesic effects of NSAIDs are attributed to inhibition of the COX-2 enzyme, whereas the negative GI effects are due to inhibition of COX-1.28 Patients taking oral anticoagulants, those with a history of peptic ulcer disease, or others at high risk for GI complications may be considered candidates for a COX-2 inhibitor or a combination of a nonselective NSAID with a gastroprotective agent such as a proton pump inhibitor (PPI). Because most PPIs are available by prescription only, such patients should be referred to a physician. 

Although the risk of GI complications is relatively small with short-term therapy, coadministration with a proton pump inhibitor should be considered in elderly patients and others at increased GI risk. NSAIDs should be used with caution in individuals with a history of peptic ulcer disease, heart failure, uncontrolled hypertension, renal insufficiency, coronary artery disease, or if they are receiving anticoagulants concurrently. 

CHCs are contraindicated in women with a history of thromboembolic events and in those at risk due to prolonged immobilization with major surgery unless they are taking anticoagulants. 

Bevacizumab, a recombinant, humanized monoclonal antibody, neutralizes vascular endothelial growth factor. The addition of bevacizumab to doublet chemotherapy is recommended in advanced NSCLC of nonsqua-mous cell histology in patients with no history of hemoptysis and no CNS metastasis who are not receiving therapeutic anticoagulation. 

Hematologic effects Aspirin interferes with hemostasis. Avoid use if patients have severe anemia, history of blood coagulation defects, or take anticoagulants. Long-term therapy To avoid potentially toxic concentrations, warn patients on long-term therapy not to take other salicylates (nonprescription analgesics, etc). Salicylism Salicylism may require dosage adjustment. 

Kondstaal P. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 1999. Issue 4. 

IV.b.2.1. Prevention of non-steroidal associated ulcer. Risks of precipitating such ulcers by non-selective COX therapy are particularly large in the elderly, in those receiving concurrent cardiovascular prophylaxis with aspirin, and in those receiving concurrent oral corticosteroids or anticoagulants and in those with histories of prior ulcer. 

Contraindications Active internal bleeding, arteriovenous malformation or aneurysm, cerebrovascular accident (CVA) with residual neurologic defect, history of CVA (within the past 2 yr) or oral anticoagulant use within the past 7 days unless PT is less than 1.2 X control, history of vasculitis, hypersensitivity to murine proteins, intracranial neoplasm, prior IV dextran use before or during percutaneous transluminal coronary angioplasty (PTCA), recent surgery or trauma (within the past 6 wk), recent (within the past 6 wk or less) GI or GU bleeding, thrombocytopenia (less than 100,000 cells/pl), and severe uncontrolled hypertension... 

COX-2 specific inhibition good choice for patients with inflammatory conditions who are at high risk of gastrointestinal adverse effects (e.g., older than 60 years history of peptic ulcer disease prolonged, high-dose NSAID therapy concurrent use of corticosteroids or anticoagulants)... 

Use with caution in older patients with Renal impairment, Hepatic impairment, Cardiovascular Disease, CHF, HTN, PUD, History of GI bleeding, GERD, Bleeding and platelet disorders. History of aspirin sensitivity reaction. Also use with caution in patients taking Anticoagulants, Aspirin, and Ant (hypertensive agents. 

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