Managing Complications of Anticoagulant Therapy

Abstract

Understanding the frequency, risk factors, and management of anticoagulant-induced adverse events will assist clinicians in optimizing patient outcomes. The most frequent adverse event of all anticoagulants is major bleeding. Risk factors for major bleeding have been identified with the heparin compounds, the direct thrombin inhibitors (DTIs), fondaparinux, and warfarin therapy. Understanding these risk factors can help prevent bleeding events. For cases of clinically significant bleeding, reversal agents exist primarily for heparin and warfarin. Although less common, nonbleeding adverse events of anticoagulant therapy can also be life threatening. The heparin compounds are associated with the development of heparin-induced thrombocytopenia (HIT) and osteoporosis. HIT can result in life-threatening thrombosis and is usually managed with a DTI. Nonbleeding adverse events with warfarin therapy include skin reactions and the development of venous limb gangrene. Appropriate initiation of warfarin therapy may decrease the risk of venous limb gangrene.