Anticoagulation medications management

On a routine anticoagulation clinic evaluation, the patient s INR was elevated to 4.1 from 2.5 obtained at the prior monthly visit, albeit with no clinical evidence of bleeding. There was no reported change in any of her medication regimens, diet, or lifestyle. However, the patient indicated that she had been consuming one cup of a concentrated herbal tea made from dried fruits of L. barbarum L. several times a day, to manage blurred vision secondary to a sore eye. When she presented to the clinic, the vision problems had already resolved. The patient was advised to discontinue... 

This statement strongly advocates for active involvement of pharmacisfs in all phases of medication use. Other standards, such as number 18, which advocates for use of dedicated anti-thrombotic (anti-coagulation) services that facilitate coordinated care management supports those pharmacists who have developed anticoagulation expertise and services. The broad-based support of these standards is a strong statement of the value that pharmacists provide to patients and other members of the health care team. 

This group of compounds have a 4-hydroxycoumarin ring with different side-chain substituents at the 3-position. Commonly used superwarfarin anticoagulant rodentieides in this group are bromadiolone, brodifacoum, coumate-tralyl, coumafuryl, and difenacoum. Brodifacoum, difena-coum and bromadiolone are three of the most commonly used rodentieides around the world. Brodifacoum is the most frequently used rodenticide in the USA. These rodentieides share most of their physical and chemical characteristics, as well as their toxicokinetics, toxicody-namics, and mechanism of toxicity, and the medical toxicological management is the same for all superwarfarins. 

Table 1 Frequency of hemorrhage and thromboembolism with routine medical care versus pharmacist-managed anticoagulation clinics...

AC, Pharmacist-managed anticoagulation clinic RMC, routine medical care. NA, not available. 

Responsibilities for management of chronic and preoperative medication need to be clearly defined and communicated between all involved caregivers. Timely prescription (e.g. treatment of preoperative anemia), reliable continuation (e.g. beta-blockers, aspirin, statins) [2], timely discontinuation (e.g. metformin, platelet inhibitors, new oral anticoagulants), and effective bridging (insulin, unfractionated heparin) of preoperative medications increase patient safety by reducing risks of myocardial ischemia, bleeding and transfusion, and help to avoid case cancellations. 

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