Overcoming the hesitancy of physicians like Ahmed by introducing antidotes to the NOACs could potentially increase the percentage of patients who receive appropriate oral anticoagulation therapy, Kowey said, although it's hard to say how much of an increase above 60% could be expected. "Patients and family need to clearly understand the risk and benefit of frequent inconveniences of checking INRs and dietary and OTC restrictions with Coumadin versus rare chance of dying helplessly after an accidental bump or fall with the newer drugs."Īhmed noted that the risk of bleeding is especially concerning for older patients because of their elevated risks of balance problems and falling. "Bleeding on anticoagulation is real, though not common, and even a single bleeding death is too many," he told MedPage Today. Ali Ahmed, MD, MPH, a geriatrician at the University of Alabama at Birmingham, said that the main reason he doesn't use the NOACs in his older patients is because of the lack of antidotes. Report prolonged or excessive injection-site reactions to the. Any signs of increased clotting should be reported immediately.Īssess injection site for pain, swelling, irritation, or bruising. HIT can occur during and up to several weeks after heparin therapy. Although most cases of HIT are minor and asymptomatic, some patients may experience life- or limb-threatening platelet clots, resulting in myocardial infarction, ischemic stroke, acute leg ischemia, or venous thromboembolism. Although the risk of HIT is lower compared with traditional heparin, enoxaparin may initiate an immune reaction in certain patients where antibodies attack circulating platelets. Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.īe alert for acute arterial or venous thrombosis caused by heparin-induced thrombocytopenia (HIT).
Notify physician or nursing staff because severe cases can lead to life-threatening arrhythmias and paralysis.Īssess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Monitor signs of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician or nursing staff immediately if these signs occur. Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, bruising, and pale skin. Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention or vasodilation. Notify physician or nursing staff immediately if enoxaparin causes excessive anticoagulation.Īssess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Notify physician or nursing staff immediately if these signs occur.Īssess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. In patients with DVT, watch for signs of pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Request or administer objective tests (Doppler ultrasound) if symptoms increase. Monitor symptoms of DVT (pain, swelling, warmth, redness) to determine if drug therapy is effective in preventing or reducing venous thrombosis.
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