Anticoagulants used :
Doctors currently have three major classes of drugs: heparin , anti -vitamin K, slow but long-acting , and fibrinolytic .
Indications anticoagulants :
Anticoagulants are prescribed as a preventive or curative in the following conditions:
• coronary insufficiency and especially myocardial infarction
• Some heart failure
• The arteritis , phlebitis , thrombosis and embolism
• The cardiac rhythm before their regularization
• During the postoperative period in abdominal , pelvic and orthopedic surgery
This information will be tempered by cons -indications related field and in particular age or pregnancy
Cons -indications to anticoagulants :
Due to arterial status , especially the brain floor, the elderly , anticoagulants are cons -indicated after 75 years. These drugs are also cons - indicated in subjects with hemostasis is imperfect : cirrhosis with liver failure, thrombocytopenic patients , hemophiliacs, and in the patient with gasro ulcers . In pregnant women , anticoagulant therapy should be minimized; Under no circumstances should administer vitamin K. You should know that many common drugs can increase the action of anticoagulants. These are :
• Aspirin
• Corticosteroids
• Male hormones
• Thyroxine
• The sulfonamides
• Quinine
Finally beware of intramuscular injections in patients receiving anticoagulants, are a source of hematoma.
Accidents anticoagulants :
It is basically bleeding events , some of which are warning signs :
• hematuria
• gingival
• Epistaxis
• Bleeding
But any visceral bleeding may be due to a hemorrhagic lesion made ​​by hyper coagulability which reveals . These lesions should always be seeking Finally, you should know that the group of anticoagulants anti vitamin K are responsible for allergic cutaneous manifestation accidents , accidents of blood ( pancytopenia ) , kidney ( anuria ) and liver . Moreover, they are teratogenic and are shown against pregnant women .


Monitoring a patient on anticoagulants :
Two points are essential :
Always a patient group which we will administer anticoagulants so as to possibly transfuse quickly ;
Ensure the strict application of the requirements , especially the doses prescribed route and schedule of administration.
For the rest monitoring is twofold: clinical and laboratory .
Clinical monitoring :
This is especially the detection of bleeding events regarding nursing .
How ? The daily search for gingival hematoma to point injections intramuscular, blood in the stool or urine
Biological monitoring :
Day after day , hemostasis patient should be monitored using different tests that the nurse is the first to know the results. Biological monitoring varies anticoagulant used . The usual tests are:
Prothrombin time (PT), which tracks to follow the action of anti vitamins K. The result is given as a percentage of normal. In normal subjects , the prothrombin time was 100% . To be effective , the anticoagulant treatment must reduce between 20 and 30 %. Below 15% hemorrhagic stroke can occur ;
The international normalized ratio or INR is - to say " international normalized ratio . For a long time , the calculation of prothrombin time ( PT) was considered sufficient to monitor the anticoagulant effect, but it is being replaced by the INR . This new index is a calculation derived TP allows to standardize the results of all laboratories based reagents . The usual value of INR in the subject untreated is 1 . It is between 3 and 4 in case of hyper effective therapeutic clotting .

How to deal with an accident anticoagulants ?
In case of hemorrhagic stroke :
Of course, it is necessary to group the patient if it is not already, call your doctor immediately and decrease the anticoagulant dose. Then begins a clinical and biological monitoring as we have outlined above. In particular, pulse, blood pressure measured by the doctor prescribed rate will be recorded on a sheet of resuscitation. Such resuscitation allows detection of a collapse at the beginning stage . It must be continued for as long as the treatment of accident.
This treatment includes : before typing the patient or while waiting for the cover of blood , infusion of macromolecular solutes
After grouping the patient , blood transfusions iso group ABO and rhesus
In severe cases , it preferable to infuse blood fractions enriched in coagulation factors
Moreover, depending on the type of anticoagulant responsible for the accident treatment is completed by:
The administration of vitamin K1s'il is an accident by anti vitamin K. You should know that vitamin K1 act only 36 h
The injection of protamine sulfate in the case of an accident by the heparin . Ten milligrams of protamine sulfate neutralizes heparin ten milligrams .
If hemorrhagic incident .
Simply decrease the anticoagulant dose , determined by the physician, is generally sufficient. The same " tactics " will be adopted if , in the absence of bleeding , the patient is biologically clotting hypo too strong . This is the case for example when the prothrombin time is less than 15 % . We keep stopping treatment abruptly not increase the risk of thromboembolism . We must emphasize the importance of patient education in the prevention of risks related to anticoagulant therapy .
In case of non hemorrhagic stroke :
He noted symptomatic treatment and the choice of another anticoagulant drug.
Behavior in case of INR too high :
It is necessary to limit the risk of bleeding , but we must also avoid the use of high doses of vitamin K1 making it impossible equilibration treatment for several days with increased risk of thrombosis. The proposed lines are summarized in the table below.

Circumstances What to do
INR <5 , no bleeding , no planned surgery Delete the next dose , then reduce subsequent doses
INR between 5 and 9 , no or minimal bleeding Stop taken prescribe 1à2 mg vitamin K1 orally , daily INR resume AVK lower dose when the INR within the therapeutic range returns .
INR sup. 9 , no bleeding , understanding instructions 3A5 mg vitamin K1 orally (or 1-5 mg IV by slow infusion ) , 6 hours after INR ( INR renew vitamin K1si not sufficiently decreased) , resume AVK lower dose when the INR within the therapeutic range returns .
INR sup. 9 , hemorrhage or even minimal doubt on the ability to follow instructions Ditto + hospitalization.
Major bleeding or high INR Hospitalization, vitamin K1 10 mg slow IV , repeated if necessary every 6 hours depending on the degree of urgency, PFC infusion . After treatment with high doses of vitamin K1, will observe a period before returning to the effectiveness of VKA ; In this case, you must use heparin until VKA be effective, and especially avoid excessively increasing the dosage of these