The Nurse Practitioner is prescribing anticoagulant therapy. What diagnostic studies should she evaluate prior to initiation of therapy and why?
please use professional peer-reviewed articles please explain why you\’d do these test and what they measure and why they are important fro A NP prescribing them
Nursing Pharmacology
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Nursing Pharmacology
Introduction
Anticoagulation medications are recommended to patients at risk of experiencing blood clots. The drugs prevent blood clots and associated complications, such as heart attacks and strokes. Anticoagulants can be dangerous since they can block blood from flowing to essential organs such as the brain, hearts, and lungs, especially when the prescriber fails to assess the patient properly (Joint Commission, 2018). This paper explains diagnostic studies that therapists should evaluate before initiation of anticoagulant therapy.
The most common anticoagulant medications were vitamin K antagonists (VKA), including warfarin. In recent years, doctors have preferred the use of direct oral ACs (DOACs) (Angel et al., 2019). Doctors believe that DOACs medications are superior to VKA anticoagulant drugs. Regardless of the type of anticoagulant drug used, proper patient assessment is necessary to obtain adequate diagnostic information. Patient assessment and diagnostic tests are recommended to prevent severe complications that are likely to arise due to anticoagulant therapy.
According to (Joint Commission, 2018). anticoagulation medications cause detrimental effects to the patient due to insufficient monitoring, complex dosing, patient characteristics, and inconsistent patient compliance. Bleeding is the most common complication related to all anticoagulants. Furthermore, direct oral anticoagulants have varied reversal mechanisms. To avoid significant bleedings and other complications of the medications, healthcare organizations should strictly follow evidence-based guidelines when using anticoagulants (Angel et al., 2019). Appropriate diagnostic studies ensure that patients taking the drugs are safe (Joint Commission, 2018). Patients on heparin and warfarin may need laboratory tests such as s partial thromboplastin time (PTT) and international normalized ratio (INR).
According to Tomaselli et al. (2017), assessment of bleeding severity is essential in patients using coagulants to achieve homeostasis. The therapist must collect vital signs and laboratory evaluation during the initial assessment. The diagnostic statistics doctors may inquire about before imitating anticoagulant therapy include prothrombin time (PT) and activated partial thromboplastin time (aPTT) (Joint Commission, 2018). The two tests are essential to any patient who needs an urgent unplanned procedure or presents with clinically relevant bleeding. Prothrombin time (PT) is a blood test that measures the time it takes for blood to clot. Prothrombin time (PT) is also called international normalized ratio (INR), which is a way of standardizing the results of PT. Patients with INR values of 1.1 or below are considered healthy and may not take any anticoagulant (Tomaselli et al., 2017). However, An INR value between 2.0 and 3.0 is ideal for taking warfarin. On the other hand, the normal range for aPTT test is around 21 to 35 seconds. Both tests measure the same thing, though, using different pathways.
When using dabigatran, the therapist may assess tests such as the dilute thrombin time, ecarin clotting time, and ecarin chromogenic assay. These laboratory tests are not readily available, especially in an emergent situation. If the tests are absent, aPTT and PT may be used in their place (Tomaselli et al., 2017). During a physical examination, the doctor may assess whether the patient is bleeding at a critical site, having hemodynamic stability, or having clinically overt hemoglobin reductions. If the patient experiences any of the situations, it indicates major bleeding symptoms, and the therapist can forego or stop OAC.
Conclusion
Anticoagulation medications are designed to prevent blood clots. Proper assessment is necessary before starting any anticoagulation drug. Bleeding is the most common complication of such drugs. Obtaining useful diagnostic studies can prevent bleeding disorders and other complications. Some of the tests to consider include prothrombin time (PT) and activated partial thromboplastin time (aPTT). These tests provide good insights for decision-making.
References
Angel, Y., Zeltser, D., Berliner, S., Ingbir, M., Shapira, I., Shenhar‐Tsarfaty, S., & Rogowski, O. (2019). Hospitalization as an opportunity to correct errors in anticoagulant treatment in patients with atrial fibrillation. British journal of clinical pharmacology, 85(12), 2838-2847. https://doi.org/10.1111/bcp.14116
Joint Commission. (2018). National Patient Safety Goal for anticoagulant therapy. R3 Report: Requirement, Rationale, Reference. https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_19_anticoagulant_therapy_rev_final1.pdf
Tomaselli, G. F., Mahaffey, K. W., Cuker, A., Dobesh, P. P., Doherty, J. U., Eikelboom, J. W., … & Wiggins, B. S. (2017). 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology, 70(24), 3042-3067. https://www.researchgate.net/publication/321453905_2017_ACC_Expert_Consensus_Decision_Pathway_on_Management_of_Bleeding_in_Patients_on_Oral_Anticoagulants