, Volume 25, Issue 1, pp 85-90

Managing anticoagulant related coagulopathy

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Background

There are several parenteral anticoagulants in use currently in the US. These include unfractionated heparin (UFH) commonly referred to as heparin, low-molecular weight heparins (LMWHs), synthetic pentasaccharide (fondaparinux), vitamin K antagonists (VKA) and direct thrombin inhibitors. The properties including mode of elimination, half-life, antidote and dose adjustment in renal failure of these drugs are listed in Table 1. VKA are the only orally approved anticoagulants with warfarin being the most commonly used in the United States with approximately three million users. This number of chronic warfarin users continues to increase annually as the baby boomers age and as patients over the age of 65 increase. It is estimated that approximately 26,000 major bleeding events occur annually in the United States. According to a recent study the incidence of anticoagulant associated intracerebral hemorrhage, the most feared and morbid bleeding complication, has quintupled in the U