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