Nursing considerations in anticoagulant therapy

With any anticoagulation therapy, there is a risk of serious bleeding leading to hospitalisation or death. Nursing care provided to clients needs to address this risk, along with specific issues related to individual drugs. Screening, education and monitoring for bleeding are key nursing roles in the provision of care to this group of clients.

Screening

People at high risk of VTE or stroke, requiring anticoagulation, may nevertheless be unsuitable for a number of reasons. Absolute contraindications for anticoagulant therapy include active bleeding, bleeding disorders, uncontrolled hypertension, acute stroke or thrombocytopaenia. Anticoagulants should not be administered within 4 hours prior or 12 hours following lumbar puncture or spinal, epidural and regional anaesthesia (NICE, 2010). There are also drug- or condition specific contraindications e.g. warfarin cannot be given in pregnancy as it causes birth defects.

Screening of patients includes history of medication compliance, memory impairment, family or caregiver support, and use of other medicines including over-the-counter and complimentary therapies. Recent research indicates compliance with warfarin therapy is also affected by education and employment status (Platt, et al., 2010). Evaluation of health beliefs and beliefs about the role of the proposed drug in treating the condition is valuable. Repeat screening for those on long-term therapy is important as life conditions and health beliefs can change (Witt, 2010). The impact of on-going monitoring and follow-up should also be evaluated. Candidacy for self-testing or point-of-care testing of INR could also be assessed. Difficulty accessing laboratory testing facilities has an impact on care.