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Anticoagulation: managing adverse events in patients receiving anticoagulation and perioperative care.
[heparin-induced thrombocytopenia]
When
patients
present
with
major
or
life-threatening
bleeding
due
to
warfarin
use
,
rapid
reversal
with
coagulation
factors
and
vitamin
K
often
is
warranted
.
Oral
vitamin
K
should
be
administered
if
the
international
normalized
ratio
is
greater
than
10
with
no
evidence
of
bleeding
,
but
its
use
is
not
recommended
if
international
normalized
ratios
are
between
4
.
5
and
10
.
The
most
important
factor
in
the
risk
of
hemorrhage
is
the
intensity
of
warfarin
therapy
.
Increasing
the
time
in
the
therapeutic
range
results
in
lower
rates
of
thrombosis
and
bleeding
.
There
are
no
available
specific
reversal
agents
or
pharmacologic
antidotes
for
the
new
oral
anticoagulants
.
Use
of
anticoagulation
management
services
(
eg
,
intervention
using
automated
hospital
information
system-generated
triggers
from
laboratory
and
pharmacy
data
)
in
the
outpatient
and
inpatient
settings
can
be
considered
to
decrease
the
risk
of
complications
for
patients
taking
anticoagulants
.
Services
that
incorporate
clear
communication
,
evidence-based
drug
management
,
and
patient
education
are
important
to
ensure
safe
use
of
anticoagulants
.
Management
of
heparin-induced
thrombocytopenia
should
include
heparin
discontinuation
and
initiation
of
a
nonheparin
anticoagulant
.
Diseases
Validation
Diseases presenting
"international normalized ratios"
symptom
heparin-induced thrombocytopenia
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