An outpatient anticoagulation protocol managed by a vascular nurse-clinician. Am J Surg 1990 Nov;160(5):501-5
Date
11/01/1990Pubmed ID
2240384DOI
10.1016/s0002-9610(05)81015-3Scopus ID
2-s2.0-0025085794 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
Lifetime anticoagulation has become a therapeutic option for surgical patients with hypercoagulable states or prosthetic arterial bypass grafts. However, physicians may not achieve optimal anticoagulation or may attempt to limit the length of the therapy period because of the perceived morbidity from hemorrhagic complications of Coumadin therapy. A protocol for anticoagulant therapy monitored and regulated by a vascular nurse-clinician was reviewed. Coumadin was prescribed for 1,891 patient-months to 93 patients to maintain their prothrombin time 1.5 to 2 times control (range: 18 to 24 seconds). The mean (+/- SD) prothrombin time for the study population was 19.8 +/- 1.8 seconds. During follow-up, 472 (14%) of 3,479 prothrombin times measured were below the therapeutic range (n = 232) or prolonged (n = 240), prompting an adjustment in the Coumadin dose in 82 (88%) patients. Four patients developed recurrent vascular graft thrombosis while receiving anticoagulation. There were 6 major and 11 minor hemorrhagic complications. Patients with a chronic risk for arterial or venous thrombosis can have out-patient anticoagulant therapy administered at optimal intensity and regulated safely with a low incidence of hemorrhagic and thrombotic events.
Author List
Seabrook GR, Karp D, Schmitt DD, Bandyk DF, Towne JBMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Ambulatory Care
Anticoagulants
Clinical Protocols
Female
Hemorrhage
Humans
Male
Middle Aged
Nurse Clinicians
Thrombosis
Warfarin
