Anticoagulants
DANGEROUS DRUG
PREGNANCY CATEGORY C (HEPARIN, APIXABAN, DABIGATRAN, RIVAROXABAN)
PREGNANCY CATEGORY X (WARFARIN)
PREGNANCY CATEGORY B (LOW–MOLECULAR-WEIGHT HEPARINS)
Therapeutic Actions
Oral anticoagulants interfere with the hepatic synthesis of vitamin K–dependent clotting factors (factors II, prothrombin, VII, IX, and X), resulting in their eventual depletion and prolongation of clotting times; parenteral anticoagulants interfere with the conversion of prothrombin to thrombin, blocking the final step in clot formation but leaving the circulating levels of clotting factors unaffected.
Indications
Treatment and prevention of pulmonary embolism and venous thrombosis and its extension
Treatment of atrial fibrillation with embolization
Prevention of DVT
Prophylaxis of systemic embolization after acute MI
Prevention of thrombi following specific surgical procedures and prolonged bed rest (low–molecular-weight heparins)
Unlabeled uses: Prevention of recurrent TIAs and MI
Contraindications and Cautions
Contraindicated with allergy to the drug; SBE; hemorrhagic disorders; TB; hepatic diseases; GI ulcers; renal disease; indwelling catheters, spinal puncture; aneurysm; diabetes; visceral carcinoma; uncontrolled hypertension; severe trauma (including recent or contemplated CNS, eye surgery, recent placement of IUD); threatened abortion, menometrorrhagia; pregnancy (oral drugs cause fetal damage and death); or lactation (heparin if anticoagulation is required).
Use cautiously with heart failure, diarrhea, fever, thyrotoxicosis; patients with dementia, psychosis, depression.
Adverse Effects
Bleeding: Hemorrhage; GI or urinary tract bleeding (hematuria, dark stools; paralytic ileus; intestinal obstruction from hemorrhage into GI tract); petechiae and purpura, bleeding from mucous membranes; hemorrhagic infarction, vasculitis, skin necrosis of female breast; adrenal hemorrhage and resultant adrenal insufficiency; compressive neuropathy secondary to hemorrhage near a nerve
Dermatologic: Alopecia, urticaria, dermatitis
GI: Nausea, vomiting, anorexia, abdominal cramping, diarrhea, retroperitoneal hematoma, hepatitis, jaundice, mouth ulcers
GU: Priapism, nephropathy, red-orange urine
Hematologic: Granulocytosis, leukopenia, eosinophilia
Other: Fever, “purple toes” syndrome
