References: Murtagh J. Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill; 2010.
|
|
- Austen McCoy
- 6 years ago
- Views:
Transcription
1 This presentation is designed to be delivered to people who work in a health care setting; such as nurses, carers and other nursing home staff. If you are an accredited pharmacist, you can use this presentation to help you deliver QUM services to a residential aged care facility. The first part of this presentation will address the features of warfarin, including indications for use, measuring INR, side effects and drug interactions. The second part of this presentation, will address patient education and important information that patient s taking warfarin should know. 1
2 Warfarin is the most widely used anticoagulant in the Western World. In the early 1950s, warfarin was approved for use as an anticoagulant, following its initial use as a pesticide. Warfarin works by inhibiting the Vitamin K dependent synthesis of clotting factors ll, Vll, lx and X in the liver. The degree of inhibition of these clotting factors is dependant upon the dose of warfarin administered i.e. the more warfarin administered, the greater the degree of anti-coagulation or bleeding. Anticoagulants, such as warfarin, do not have any effect on a established thrombus (or blood clot). However, once a thrombus has occurred, treatment with an anticoagulant can work to prevent further extension of this formed clot and prevent secondary complications. Murtagh J. Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill;
3 Warfarin has a variety of clinical indications. These are summarised on this slide. Reference: 1. WA Medication Safety Group. Living with warfarin; Information for Patients. [Online] [accessed 7 Dec 2011]. At: 948_warfarin_B.pdf 2. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p310 3
4 Acute treatment with warfarin is required for: Pulmonary Embolism (PE): treatment continues generally for 4 to 6 months Deep Vein Thrombosis (DVT): as a result of surgery or immobilisation, treatment continues generally for 8 to 12 weeks 1. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p310 4
5 Ongoing treatment with warfarin is required for the following conditions (after careful review of the patient s overall cardiovascular risk and risk of major bleeding with the treatment): Unprovoked or recurrent DVT Atrial fibrillation - Anticoagulant therapy with warfarin should be considered to prevent a first, or recurrent stroke in patients with atrial fibrillation Heart failure Myocardial infarction at risk of stroke Stroke prevention - warfarin reduces the relative risk of stroke in non-valvular AF. People with a previous stroke or transient ischaemic attack benefit from warfarin. 1. WA Medication Safety Group. Living with warfarin; Information for Patients. [Online] [accessed 7 Dec 2011]. At: 948_warfarin_B.pdf 2. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p310 5
6 Warfarin therapy is monitored by analysing the Prothrombin Time (PT). PT is the most commonly used test to monitor anticoagulant therapy. PT is usually expressed as the International Normalised Ratio (INR). The equation for the calculation of PT is displayed on this slide. The dose of warfarin must be individualised for each patient according to the patient s sensitivity to the medicine. The prescriber will adjust the dose based on a measure of the patient s prothrombin (PT) time. The PT time is based on interactions of the clotting factors (I, II, V, VII & X) which are synthesised by the liver. This will be discussed in more depth later in this presentation, when we address the aspect of INR testing with warfarin use. 6
7 The INR is the ratio of patient PT to control PT, multiplied by a correction factor called international sensitivity index (ISI- which is determined by the World Health Organisation and aims to standardise the test). It is a simple in vitro clotting assay which assesses the effect of warfarin on the coagulation system. A person not taking warfarin has a INR of about 1. The INR therapeutic range for all indications (except for those with heart valves) is between 2 and 3. Safety and efficacy of warfarin depends on maintaining the INR within the therapeutic range. The therapeutic range represents the levels at which therapy should be effective without an excessive risk of bleeding. The INR result reflects the warfarin dose administered hours earlier. When the INR increases, there is an increase in the risk of bleeding and the warfarin dose needs to be reduced 1. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p Murtagh J, Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill,
8 Measure INR at baseline (before starting treatment) The typical starting dose for warfarin is 5-10mg daily. The dose is then adjusted according to the INR (reference tables exist for this process). Once the INR is within the required range (dependant upon the indication of use for warfarin), a maintenance dose is established (usually around day 5 of treatment). It is important to note that the INR reflects the warfarin dose taken 48 hours earlier. INR check if change in warfarin dose changes in the patient s condition addition or removal of other medication change in diet green leafy vegetables consumption change in the amount of alcohol consumed 1. Murtagh J. Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill,
9 Warfarin is particularly prone to interactions with other drugs, herbal medicines and dietary factors. Many interactions are unpredictable, so the INR should be tested more frequently after starting a new medication and similarly when stopping a medication or changing the dose. INR measured about one week after a change in medication should reflect any interaction. These include: Age greater than 65 years; Elderly patients may exhibit an exaggerated response to warfarin, in part because they tend to store less vitamin K than younger people and therefore generally require a lower dose. Dose - The degree of inhibition of clotting factors, is dependant upon the dose of warfarin prescribed. Patient compliance - Problems with patient compliance can lead to irregular levels of warfarin in the blood stream. This can make dose adjustments difficult. Consider avoiding the use of warfarin if patient compliance is likely to be poor. The use of a dose administration aid (DAA) may be beneficial. Diet & vitamin K status - The amount of vitamin K in some foods can affect therapy with warfarin. Patient s should maintain a balanced diet and avoid any drastic changes in diet as this may affect vitamin K levels in the blood stream and can affect therapy with warfarin. Green, leafy vegetables contain high levels of vitamin K and patients should avoid eating large amounts of these. Lifestyle factors Avoid drinking large amounts of alcohol. Alcohol in small to moderate amounts probably has little effect on warfarin metabolism. In heavy drinkers, however, factors such as increased falls, alcohol-induced gastritis, poor diet and poor compliance potentiate the risk of bleeding. Other medications - Warfarin interacts with many medications when given at the same time. Refer to the tables over the next two slides for the main interactions. 9
10 There are many potential interactions between warfarin and other drugs. Importantly, some medications increase warfarin levels, whilst others decrease levels. Aspirin ( 2-4gm daily) is contraindicated while a patient is taking warfarin as this combination increases the risk of bleeding and GI upset. Low dose aspirin (100mg daily) can be given in selected patients at high risk of clotting. Close monitoring is required. In one study, recent antibiotic use was the second greatest risk factor (after age) for over-anticoagulation. Please note that this is not an exhaustive list. Patients should always check with their doctor or pharmacist before taking any other medicines with warfarin. Reference: 1. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p Murtagh J. Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill, Campbell P. Managing warfarin therapy in the community. Aust Prescriber. 2001;24:86-9. At: 10
11 Vitamin K reduces the anti-clotting effect of warfarin. Vitamin K is contained in some foods we eat. This is important to consider in situations when diet changes, such as during illness, travel, fad diets, hospitalisation and postoperatively. Foods high in vitamin K include green tea, turnips, avocados, brussel sprouts, broccoli and green leafy vegetables (e.g. lettuce, cabbage). Eat a consistent amount of these vitamin K-containing foods per week. Alcohol consumption in heavy drinkers ( above moderate intake) may cause fluctuations in INR and due to factors such as increased falls, alcohol-induced gastritis, poor diet and poor compliance potentiate the risk of bleeding. 1. WA Medication Safety Group. Living with warfarin; Information for Patients. [Online] [accessed 7 Dec 2011]. At: 948_warfarin_B.pdf 11
12 If the INR value is elevated, this may be due to over-anticoagulation or high INR and increases the risk of haemorrhage. The first step in managing this problem is to identify the cause. Common causes include starting or stopping an interacting medication, deteriorating liver function, and patient error (such as taking the wrong dose or confusing different strength tablets). Many of these causes are preventable. The approach to a raised INR should be individualised, paying attention to the indication for the warfarin, the patient's risk of bleeding and whether it is safe to continue therapy at all. Some patients need to be admitted to hospital, while others just need to miss a dose of warfarin. 1. Murtagh J. Murtagh s General Practice. 5 th edn. Sydney: McGraw Hill; Campbell P. Managing warfarin therapy in the community. Aust Prescriber. 2001;24:
13 If the patient s INR is too low, this may be due to: a lack of patient compliance a fluctuating diet foods contained high levels of vitamin K are not kept constant an individual s personal circumstances 13
14 Bleeding is the most common side effect of warfarin use. It is greatest in the first three months of starting therapy. Signs that bleeding may be occurring are: Bleeding from the gums or nose Coughing up blood Red or dark-brown coloured urine Heavy bleeding form cuts or wounds that does not stop Easy bruising Severe headache Other side effects of warfarin are skin necrosis, purple discolouration of the toes, rash, nausea, vomiting and diarrhoea. 1. Blood and Electrolytes, Warfarin. In: Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011.p INR record book. University of Tasmania. School of Pharmacy. [online] [accessed 6 Dec 2011]. At: 3. Baker RI, Coughlin PB, Gallus AS, Harper PL, Salem HH, Wood EW. Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Medical Journal of Australia. 2004; 181:
15 The risk of haemorrhage must be considered against the potential clinical benefit of anticoagulation when considering the patient s: Localised physical conditions General physical condition Personal circumstances These will be discussed further on the following slides. Borosak M. Warfarin: balancing the benefits and harms. Aust Prescriber.2004;27:
16 Presenter s notes: For most patients, warfarin can be withheld 5 days before elective surgery; the INR usually falls to below 1.5 in this time, and surgery can be conducted safely. Borosak M. Warfarin: balancing the benefits and harms. Aust Prescriber. 2004;27:
17 Bleeding disorders- Warfarin is contraindicated in patient s with severe active bleeding or disease states with an increased risk of severe bleeding. (e.g. uncontrolled hypertension). Patient s who are at a high risk of bleeding, such as the elderly who may be prone to falls, should be monitored carefully if warfarin therapy is prescribed. Previous gastrointestinal bleeding Alcoholism- Alcohol can increase the anticoagulant effect of warfarin. There are some conditions in which warfarin should be used with caution in patients with: Cerebrovascular disease Heart failure Renal insufficiency Hepatic impairment Malignancy Borosak M. Warfarin: balancing the benefits and harms. Aust Prescriber. 2004;27:
18 In some patients due to their personal circumstances, warfarin use must be very carefully monitored. The decision to start warfarin depends on an assessment of each patient's balance between the harmful effects and the benefits of anticoagulation. Warfarin is contraindicated if the patient is unwilling or unable to comply with monitoring due to cognitive impairment, alcoholism, psychosis or problems with accessing services. Borosak M. Warfarin: balancing the benefits and harms. Aust Prescriber. 2004;27:
19 19
Appendix 8 Patient Information Leaflet A. NPSA Web Link www.npsa.nhs.uk/easysiteweb/gatewaylink.aspx?alid=19112 B. Supplementary NT 1. WHY AM I ON WARFARIN? Your doctors have told you that you have a condition
More informationWarfarin PATIENT EDUCATION
Warfarin PATIENT EDUCATION Information for patients taking warfarin Read this booklet to learn: What warfarin is and why you are taking it What blood tests you need to use warfarin safely How other medicines
More informationWARFARIN ANTICOAGULANT RECORD
WARFARIN ANTICOAGULANT RECORD Provided as a service to medicine by Concordia International Rx UK Ltd HOSPITAL/GP PRACTICE:... Telephone:... ANTICOAGULANT CLINIC Telephone:... Name:... Address:...... Telephone:...
More informationBanner Health Center
Banner Health Center Coumadin Education Class Anticoagulation Clinic Please turn cell phones off. Thank you! The History of Coumadin 1920s: cattle deaths due to anti-clotting agent found in clover Mid-1940s:
More informationWhat is Warfarin? 1 Light Brown 3 Light Blue 5 Pink
Pharmacy Warfarin What is Warfarin? Warfarin is an anticoagulant, sometimes called a blood thinner. It prevents blood clots from forming and also prevents existing clots in the blood vessels from getting
More informationCoumadin Monitoring. (An approved NC Division of Health Service Regulation Continuing Education Course)
Coumadin Monitoring (An approved NC Division of Health Service Regulation Continuing Education Course) What is Coumadin (Warfarin) Short Answer: a blood-thinning drug Better Answer: thinner) warfarin:
More informationThings to Know When Taking Warfarin (Coumadin ) Anticoagulation Therapy
Things to Know When Taking Warfarin (Coumadin ) Anticoagulation Therapy Table of Contents Highlights... 1 Why Do I Need Warfarin (Coumadin )?... 1 Who is Going to be Taking Care of My Warfarin?... 1 What
More informationAtrial Fibrillation and Anticoagulants
Atrial Fibrillation and Anticoagulants A guide to your diagnosis and treatment Information for patients, relatives and carers For more information, please contact: York Anticoagulant Clinic Tel: 01904
More informationMANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR
MANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR 1.1 Time to lower INR Prothrombinex-VF - 15 minutes Fresh Frozen Plasma
More informationClinical Guide - Patient Information (January 2007)
Clinical Guide - Patient Information (January 2007) Principal Developer: B. Bartle Secondary Developers: J. Johnson, M-F. Scully, L. Vickars Information For Patients Taking Oral Anticoagulants You are
More informationWarfarin. Information for patients taking warfarin
Warfarin Information for patients taking warfarin Read this booklet to learn: what warfarin is and why you are taking it what blood tests you need to use warfarin safely how other medicines and diet can
More informationWarfarin - Introduction for New Users
Warfarin - Introduction for New Users Introduction Blood clots are frequent in patients who have diseases of the blood vessels or heart. Blood clots may pose a dangerous threat to some people, as they
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationVenous Thrombo-Embolism (VTE)
Venous Thrombo-Embolism (VTE) Information for service users and carers RDaSH leading the way with care Older People s Mental Health Services Reducing risk of unwanted blood clots whilst in hospital About
More information2 Summary of NICE TA 249: Atrial fibrillation - Dabigatran Etexilate
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 249: Atrial fibrillation - Dabigatran Etexilate 1 Name of Commissioning Team Long Term Conditions Commissioning Team
More informationAnticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT
Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet
More informationTreatment with Warfarin (Coumadin)
Patient Education Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. Clinic staff are also available to help. Clinics: University of Washington
More informationTreatment with Warfarin (Coumadin )
Patient Education Treatment with Warfarin (Coumadin ) Warfarin (Coumadin ) is a medicine that is used to treat and prevent blood clots in the legs, lungs, heart, brain, and other parts of the body. What
More informationGuidelines for slow loading of patients on warfarin for Atrial Fibrillation (AF) in the non acute setting
ANTICOAGULANT SERVICE Guidelines for slow loading of patients on warfarin for Atrial Fibrillation (AF) in the non acute setting Introduction Fast loading of warfarin carries a risk of over anticoagulation
More informationNHS Lanarkshire Guidance on Anticoagulant treatment for patients with non-valvular atrial fibrillation
1 NHS Lanarkshire Guidance on Anticoagulant treatment for patients with non-valvular atrial fibrillation Atrial fibrillation (AF) affects about 1.2% of the population in the United Kingdom and accounts
More informationTreatment with Warfarin (Coumadin)
UW MEDICINE PATIENT EDUCATION Treatment with Warfarin (Coumadin) What to expect This handout explains what to expect when your doctor has prescribed warfarin (Coumadin). What is warfarin? Warfarin sodium
More informationCLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES
National Patient Safety Alert RRR018 Preventing Fatalities From Medication Loading Doses (November 2010) MMCP05 CLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES INTRODUCTION
More informationMedicines for stroke prevention in atrial fibrillation. Choosing the right one for you
Medicines for stroke prevention in atrial fibrillation Choosing the right one for you Atrial fibrillation (AF) is a condition that affects the heart, causing it to beat irregularly and too fast. When this
More informationMedication Nurse Assistant Talk: Monday March 3, 2008 Topic of discussion: Anticoagulant Coumadin (Warfarin).
Medication Nurse Assistant Talk: Monday March 3, 2008 Topic of discussion: Anticoagulant Coumadin (Warfarin). Learning Objectives: 1. History of Warfarin 2. Pharmacokinetics / Pharmicodynamics of warfarin
More informationAppendix C Factors to consider when choosing between anticoagulant options and FAQs
Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened
More informationDF M5 DF M1 DF M3. Warfarin Therapy
DF M5 DF M3 DF M1 Warfarin Therapy 1 Why is this medicine prescribed? Warfarin is used to prevent formation of blood clots and existing clots from growing larger. It is often prescribed for patients with
More informationSAMPLE ONLY. UCSF Division of Pediatric Hematology/Oncology Anticoagulation Service (415)
Your Child s Health Pediatric Warfarin (Brand Name = Coumadin) UCSF Division of Pediatric Hematology/Oncology Anticoagulation Service (415) 476-3831 Warfarin is a medication commonly referred to as a blood
More informationCLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES
National Patient Safety Alert RRR018 Preventing Fatalities From Medication Loading Doses (November 2010) CP11 CLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES INTRODUCTION The
More informationNEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS
NEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS OBJECTIVES: To provide a comparison of the new/novel oral anticoagulants (NOACs) currently available in Canada. To address
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised
Name: generic (trade) Dabigatran etexilate (Pradaxa ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised Direct thrombin inhibitor
More informationBlood-thinning medication after stroke
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Blood-thinning medication after stroke Blood-thinning medicines are drugs that help to prevent clots forming in your blood. They are often prescribed
More informationBlood Thinners. Staying Safe and Healthy While Using Warfarin PATIENT SAFETY ISSUE
PATIENT SAFETY ISSUE Blood Thinners Staying Safe and Healthy While Using Warfarin Q: What are blood thinners? A: Some prescription medications are commonly called blood thinners. They may also be called
More informationTreatment with Rivaroxaban Xarelto
Treatment with Rivaroxaban Xarelto Anticoagulation Clinic This handout explains the medicine rivaroxaban, a drug that helps prevent blood clots. What is rivaroxaban? Rivaroxaban (brand name Xarelto) is
More informationA Look at Patient Compliance to INR Testing and Therapeutic Range Management of Patients on Warfarin at Agassiz Medical Center.
A Look at Patient Compliance to INR Testing and Therapeutic Range Management of Patients on Warfarin at Agassiz Medical Center Lauren Martens Abstract This study sought to determine the total number of
More informationDiagnosed with AFib? Your journey with XARELTO starts here.
THERE S MORE TO KNOW Diagnosed with AFib? Your journey with XARELTO starts here. Do not stop taking XARELTO without talking to your doctor. Stopping XARELTO increases your risk of having a stroke. 2 Welcome
More informationTreatment with Apixaban Eliquis
Treatment with Apixaban Eliquis Anticoagulation Clinic 416-530-6000 ext 3477 This handout explains the medicine rivaroxaban, a drug that helps prevent blood clots. What is apixaban? Apixaban (brand name
More informationLiving with a New Oral Anticoagulant (NOAC)
Living with a New Oral Anticoagulant (NOAC) dabigatran (Pradaxa ) rivaroxaban (Xarelto ) apixaban (Eliquis ) Information for patients Produced and made available by the Western Australian Medication Safety
More informationStroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital
Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke
More informationINFORMATION. Atrial Fibrillation. Summary. Information from the
1. Information from the For more information contact Heartline 1300 362 787 or www.heartfoundation.com.au Atrial Fibrillation INFORMATION Summary What is atrial fibrillation? Atrial fibrillation (AF) is
More informationA guide to anticoagulation management and self-testing
A guide to management and self-testing Understanding If you re reading this, you, or someone you care about, may be on oral therapy, usually treated with a vitamin K antagonist (VKA). VKAs, such as warfarin,
More informationPulmonary Embolism (PE)
Pulmonary Embolism (PE) Normally blood moves freely throughout the body without any problems. However, if a blood clot forms in a vein it can block the vein and stop the blood from flowing properly. Sometimes
More informationTreatment of deep vein thrombosis and pulmonary embolism with low molecular weight heparin
Treatment of deep vein thrombosis and pulmonary embolism with low molecular weight heparin You have been given this leaflet because you have a blood clot. Normally blood flows freely around the body without
More informationHow to Take Coumadin /Warfarin. Blood Tests
How to Take Coumadin /Warfarin Please take your pills as directed. The amount of Coumadin /Warfarin each person needs is different. The dose is based on a blood test called the INR. The amount of medication
More informationSAMPLE ONLY. Your Child s Health. A Pediatric Patient s Guide to Using Warfarin. Please order from Documents, Media and Mail: 415/
Physician Referral Service: 888/689-UCSF Your Child s Health A Pediatric Patient s Guide to Using Warfarin Warfarin (WAR-far-in) Brand Name: Coumadin The purpose of this brochure is to inform you about
More informationHELPING TO TREAT DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM
HELPING TO TREAT DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM AND PREVENT THEIR RECURRENCE PATIENT INFORMATION BOOKLET IF FOUND, PLEASE RETURN TO: If found, please return to: Name Address Phone number It
More informationResults from RE-LY and RELY-ABLE
Results from RE-LY and RELY-ABLE Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in longterm stroke prevention EXECUTIVE SUMMARY Dabigatran etexilate (Pradaxa ) has shown a consistent
More informationBlood-thinning medication after stroke
Call the Stroke Helpline: 0303 3033 100 or email: info@stroke.org.uk Blood-thinning medication after stroke Blood-thinning medicines are drugs that help to prevent clots forming in your blood. They are
More informationWarfarin & You By V. B. Blake
Warfarin & You By V. B. Blake Warfarin is an anticoagulant used to to prevent heart attacks, strokes, and blood clots. Learn about side effects, interactions and indications. Can you tell me what I should
More informationComorbidity or medical history Existing diagnoses between 1 January 2007 and 31 December 2011 AF management care AF symptoms Tachycardia
Supplementary Table S1 International Classification of Disease 10 (ICD-10) codes Comorbidity or medical history Existing diagnoses between 1 January 2007 and 31 December 2011 AF management care I48 AF
More informationAnticoagulants and Head Injuries. Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar
Anticoagulants and Head Injuries Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar Common Anticoagulants and Indications Coumadin (warfarin) indicated for
More informationNorth East Essex Medicines Management Committee
Colchester Hospital University NHS Foundation Trust North East Essex Clinical Commissioning Group North East Essex Medicines Management Committee ORAL ANTICOAGULANT (Vit K antagonist only) MANAGEMENT GUIDELINES
More informationMonitoring my anticoagulation treatment
Information for patients My pharmacist and me Monitoring my anticoagulation treatment With your pharmacist s help, your treatment is easier than ever L Association québécoise des pharmaciens propriétaires
More informationSAFE study A-fib ED Anticoagulation Package
SAFE study A-fib ED Anticoagulation Package In this package you will find documents to help you make decision making easy for the Anticoagulation of New AFib patients being discharged from the ED: 1. Anticoagulation
More informationNovel oral anticoagulant therapy (NOAC)
Haematology Department Novel oral anticoagulant therapy (NOAC) Information for patients, relatives and carers What is novel oral anticoagulant therapy? Novel oral anticoagulants, or NOACs, are drugs which
More informationEdoxaban for the treatment and prevention of venous thromboembolism (DVT or PE) or stroke prevention in non-valvular AF
Edoxaban for the treatment and prevention of venous thromboembolism (DVT or PE) or stroke prevention in non-valvular AF Traffic light classification- Amber 2 specialist initiation / recommendation Information
More informationNOACS/DOACS*: COMPARISON AND FREQUENTLY-ASKED QUESTIONS
NOACS/DOACS*: COMPARISON AND FREQUENTLY-ASKED QUESTIONS OBJECTIVES: To provide a comparison of the newer direct oral anticoagulants (DOACs) currently available in Canada. To address frequently-asked questions
More informationPrimary Care practice clinics within the Edmonton Southside Primary Care Network.
INR Monitoring and Warfarin Dose Adjustment Last Review: November 2016 Intervention(s) and/or Procedure: Registered Nurses (RNs) adjust warfarin dosage according to individual patient International Normalized
More informationbpac better e m dicine
INR Testing Quiz Feedback bpac nz better medicin e Contents INR Testing Quiz 2 Quiz Feedback: Responses from Colleagues, and Expert Review 4 bpac nz Review : Dr Janine Bailey, Motueka Dr Stephen Kuzmich,
More informationGuidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban
Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting
More informationUpdates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis. By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan
Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan Objectives Describe the prevalence of PE and DVT as it relates
More informationMEDICATION GUIDE JANTOVEN (JAN-to-ven) Tablets (Warfarin Sodium Tablets, USP)
MEDICATION GUIDE JANTOVEN (JAN-to-ven) Tablets (Warfarin Sodium Tablets, USP) Read this Medication Guide before you start taking JANTOVEN (Warfarin Sodium Tablets, USP) and each time you get a refill.
More informationDO YOU HAVE AFIB OR DVT/PE BLOOD CLOTS?
To significantly reduce stroke risk from AFib and to treat and help prevent DVT and PE blood clots DO YOU HAVE AFIB OR DVT/PE BLOOD CLOTS? GET TO KNOW HOW THIS LATEST-GENERATION BLOOD THINNER HELPS PROTECT
More informationAnticoagulants and Antiplatelet. Therapy
Anticoagulants and Antiplatelet Therapy Your Heart and Blood Clots You ve been told by your healthcare provider that you have a condition that can cause blood clots. This may be due to several factors,
More informationCommunity Pharmacy Safety in Practice Warfarin Change Package 2017
Community Pharmacy Safety in Practice Warfarin Change Package 2017 1 Community Pharmacy Safety in Practice Community Pharmacy Safety in Practice 2017/2018 is a pilot programme. We want to make it suit
More informationBlood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy
Blood Thinner Agent Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Outline: Blood thinner agent definition. anticoagulants drugs. Thrombolytics. Blood thinner agent Therapeutic interference
More informationEdoxaban. Direct Xa inhibitor Direct thrombin inhibitor Direct Xa inhibitor Direct Xa inhibitor
This table provides a summary of the pharmacotherapeutic properties, side effects, drug interactions and other important information on the four anticoagulant medications currently in use or under review
More informationHelping people with communication difficulties after stroke to understand warfarin therapy
Helping people with communication difficulties after stroke to understand warfarin therapy Satinder Bhandal, Consultant Anticoagulation Pharmacist, Buckinghamshire Healthcare Trust and UK Clinical Pharmacy
More informationDOAC the story so far... Dr GM Benson Director NI Haemophilia and Thrombosis Centre BHSCT
DOAC the story so far... Dr GM Benson Director NI Haemophilia and Thrombosis Centre BHSCT A rose by any other name.. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC
More informationWarfarin in Adults : Guidelines for the use of. These guidelines apply to all patients commenced or continuing on warfarin
Warfarin in Adults : Guidelines for the use of Document Type: Clinical Guideline Clinical Lead: Ian Neilly Author/s: Ian Neilly/Paul Barbieri Directorate: Haematology Approved by Haematology Specialty
More informationComparison of novel oral anticoagulants (NOACs)
Comparison of novel oral anticoagulants (NOACs) For guidance for full information refer to individual SPCs available at www.medicines.org.uk Licensed indications for NOACs Prevention of stroke and systemic
More informationDr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust
MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital
More informationVenous Thromboembolic Events (VTEs)
Venous Thromboembolic Events (VTEs) This Infosheet explains what a VTE is, what the causes and risk factors for VTEs are, the symptoms of a VTE, how they can be treated and some tips for self-management.
More informationShared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins
Tameside Hospital NHS Foundation Trust and NHS Tameside and Glossop Shared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins Version 5.2 Version: 5.2 Authorised by: Joint Medicines
More informationMEDICATION GUIDE ELIQUIS (ELL eh kwiss) (apixaban) tablets
MEDICATION GUIDE ELIQUIS (ELL eh kwiss) (apixaban) tablets What is the most important information I should know about ELIQUIS? For people taking ELIQUIS for atrial fibrillation: People with atrial fibrillation
More informationUnderstanding your risk of blood clots from hospital to home and how Bevyxxa may help
Understanding your risk of blood clots from hospital to home and how Bevyxxa may help People who take Bevyxxa and have medicine injected into their spinal and epidural area, or have a spinal puncture,
More informationConfirmed blood clot
n The Leeds Teaching Hospitals NHS Trust Confirmed blood clot (Deep vein thrombosis and pulmonary embolism) Information for patients Please read this leaflet carefully. It will give you information about
More informationA Patient s Guide to Using Warfarin
Your Health Matters A Patient s Guide to Using Warfarin The purpose of this brochure is to inform you about your anticoagulation therapy to ensure its effectiveness and your safety. What is Warfarin &
More informationPatients First. Warfarin Sodium (Coumadin ) You should maintain your regular diet to promote consistent effects of this medicine.
Patient Education ABOUT YOUR MEDICATIONS Warfarin Sodium (Coumadin ) You should maintain your regular diet to promote consistent effects of this medicine. Warfarin sodium (Coumadin ) is a drug that prevents
More informationTreatment of the Medically Compromised Patient
Treatment of the Medically Compromised Patient Nashville Area Continuing Dental Education Series November 3, 2010 Harry J. Brown, MD Chief Medical Officer, Nashville Area Outline General Principles Specific
More informationThrombosis and Anticoagulation Team. Warfarin. Information for patients, relatives and carers
Thrombosis and Anticoagulation Team Warfarin Information for patients, relatives and carers What is warfarin? Warfarin is an anticoagulant. Anticoagulants are drugs which prevent harmful blood clots forming
More informationAMPLA HEALTH ANTICOAGULATION CLINIC
AMPLA HEALTH ANTICOAGULATION CLINIC Dear Warfarin / Coumadin user: This educational handbook is for patients receiving Warfarin / Coumadin therapy through Ampla Health Anticoagulation Clinic. Patients
More informationAtrial Fibrillation Implementation challenges. Lesley Edgar Ross Maconachie
Atrial Fibrillation Implementation challenges Lesley Edgar Ross Maconachie Atrial Fibrillation Most common heart rhythm disturbance Rapid and irregular electrical signals Reduced efficiency of blood flow
More informationEdoxaban Treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA354)
Rationale for Initiation, Continuation and Discontinuation (RICaD) Edoxaban Treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA354) This document supports the
More informationYour guide to taking LENVIMA for hepatocellular carcinoma (HCC), a type of liver cancer
Your guide to taking LENVIMA for hepatocellular carcinoma (HCC), a type of liver cancer LENVIMA is a prescription medicine that is used by itself as the first treatment for a type of liver cancer called
More informationPrescriber Guide Date of preparation: January 2018
Prescriber Guide Date of preparation: January 2018 Table of Contents Patient Information Booklet 2 Patient Alert Card 2 Assessing stroke risk CHA 2DS 2-VASc 3 Assessing bleeding risk HAS-BLED 3 Therapeutic
More informationpatient group direction
ASPIRIN v01 1/8 ASPIRIN PGD Details Version 1.0 Legal category P Staff grades Approved by Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner (Nurse)
More informationVitamin K. Amina Ziyad Elaf Sohaib
Vitamin K Amina Ziyad Elaf Sohaib What is Vitamin K? Fat soluble compound Necessary for the synthesis of several proteins required for blood clotting 1) Vit K 1 (Phylloquinone) - natural form - found in
More informationDiagnosed with DVT/PE blood clots? Your journey with XARELTO starts here.
THERE S MORE TO KNOW Diagnosed with DVT/PE blood clots? Your journey with XARELTO starts here. Do not stop taking XARELTO without talking to your doctor. Stopping XARELTO increases your risk of having
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationVENOUS THROMBOEMBOLISM PHARMACOLOGY. University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D
VENOUS THROMBOEMBOLISM PHARMACOLOGY University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D LEARNING OBJECTIVES Know what factors anticoagulant medications
More informationDIRECT ORAL ANTICOAGULANTS: WHEN TO USE, WHICH TO CHOOSE AND MANAGEMENT OF BLEEDING
DIRECT ORAL ANTICOAGULANTS: WHEN TO USE, WHICH TO CHOOSE AND MANAGEMENT OF BLEEDING KATHERINE STIRLING CONSULTANT PHARMACIST ANTICOAGULATION AND THROMBOSIS DR LISHEL HORN CONSULTANT HAEMATOLOGIST HAEMOSTASIS
More informationRivaroxaban film coated tablets are available in 2 strengths for this indication: 15mg and 20mg.
Primary Care Prescriber Information RIVAROXABAN (XARELTO ) Treatment of acute venous thromboembolism and prevention of recurrent venous thromboembolism INDICATION Rivaroxaban is a non-vitamin K antagonist
More information1. What is fulvestrant?
Talk to our breast care nurses 0808 800 6000 1. What is fulvestrant? 2. How does fulvestrant work? 3. When might fulvestrant be prescribed? 4. How is fulvestrant given? 5. How long will I be given fulvestrant
More informationTo prevent blood clots after hip or knee replacement surgery This booklet contains information for those who have been prescribed ELIQUIS (apixaban)
To prevent blood clots after hip or knee replacement surgery This booklet contains information for those who have been prescribed ELIQUIS (apixaban) after hip or knee replacement surgery Always read the
More informationPatient Information. Preventing and treating blood clots
Patient Information Preventing and treating blood clots 1_Clexane_Patient_Booklet_AW05.indd 1 8/04/2016 11:26 a The information provided in this document is for patients prescribed CLEXANE, and should
More informationPrescribing and Monitoring of Warfarin
Prescribing and Monitoring of Warfarin 1. Introduction Warfarin is used in the management of patients and conditions including postmyocardial infarction, atrial fibrillation, DVTs and other clinical scenarios.
More informationEdoxaban For preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA 355)
Rationale for Initiation, Continuation and Discontinuation (RICaD) Edoxaban For preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA 355) This document supports
More informationStandard Operating Procedure for. the Safe Administration of Dalteparin (Fragmin), Tinzaparin (Innohep) and Enoxaparin (Clexane) in the Community
Standard Operating Procedure for the Safe Administration of Dalteparin (Fragmin), Tinzaparin (Innohep) and Enoxaparin (Clexane) in the Community DOCUMENT CONTROL: Version: 2. Ratified by: Quality Assurance
More informationUW MEDICINE PATIENT EDUCATION. Treating Blood Clots. What is a blood clot? DRAFT
UW MEDICINE PATIENT EDUCATION Treating Blood Clots About deep vein thrombosis (DVT) and pulmonary embolism (PE) and how they are treated This handout explains blood clots, their symptoms, and how they
More informationPosition statement: Anti-coagulants and Risk Assessment
Position statement: Anti-coagulants and Risk Assessment Document information Protective marking: NOT PROTECTVELY MARKED Author: Matt Johnston Force/Organisation: College of Policing NPCC Coordination Committee
More information