Reduce Adverse Drug Events Involving Anticoagulants

Medications for anticoagulation have many benefits, but also many risks. Careful monitoring of laboratory values is essential to maintaining the balance between under-coagulation, which can result in development of clots, and over-coagulation, which increases the risk of bleeding and hemorrhage. Dosages require adjustments, sometimes frequently, but adjustments must be made carefully and with a variety of data in mind, including laboratory values for coagulation and renal function, diet, clinical condition, weight, and age.


The use of standardized practices in the hospital setting can greatly reduce the chances of an adverse event from anticoagulants. Patients taking anticoagulants often continue taking the medications after they leave the hospital, so care providers must communicate ample information during the inpatient period and give proper patient education for self-management.


Changes for Improvement

Use Guidelines or Pre-Printed Orders for Vitamin K

Implement Weight-Based Heparin Protocols

Use Programmable Pumps and Independent Double-Checks for IV Anticoagulants

Develop a Warfarin Dosing Service or Clinic

Use Alarm Devices to Ensure Consistent Anticoagulant Dosing

Use Pre-Mixed Heparin Solutions

Provide Coagulation Test Results Within Two Hours or at Bedside

Use Dosing Charts for Heparin

Prepare All Heparin Doses and Solutions in the Hospital Pharmacy

Continue to Use Anticoagulation Flowsheets after Discharge

Implement Patient-Directed Administration of Warfarin

Educate Patients to Manage Warfarin Therapy at Home

Develop Weekly Dosing Regimens for Anticoagulants

Titrate Anticoagulant Doses

Eliminate Heparin Flush of Peripheral Intravenous Lines

Standardize International Normalized Ratio Testing Equipment

Adjust Anticoagulants with Thrombolytic and G2b/3A Inhibitors

Use Anticoagulation Flowsheets

Use Low Molecular Weight Heparin (LMWH)

Eliminate the Use of Heparin Solution with Arterial Lines

Allow Pharmacists to Manage an Anticoagulant Service


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