Cardinal Health

Preventing Venous Thromboembolism: A Healthcare Professional Guide to Intervention 17 The Body’s Natural Mechanisms Natural Anticoagulants • Protein C, Protein S. • Protein Z-Dependent Protease Inhibitor/Protein Z. • Antithrombin. • Tissue Factor Pathway Inhibitor. Slow down the process of blood coagulation. Natural Platelet Aggregation Inhibitors. • Nitric Oxide/EDRF, Prostacyclin. Natural Fibrinolytic Enzyme. • Plasmin. Breaks down fibrin within blood clots. Medications Anticoagulants. • LowMolecular Weight Heparin (enoxaparin, dalteparin) • Low Dose Unfractioned Heparin (heparin sodium) • Direct Thrombin Inhibitor (dabigatran) • Factor Xa Inhibitors (rivaroxaban, apixaban, fondaparinux) • Vitamin K Antagonist (warfarin) Antiplatelets. • Aspirin Fibrinolytic Agents. • Alteplase, Tenecteplase, Urokinase Pharmacological Prophylaxis of VTE. A. What pharmacological agents are currently used to prevent VTE in Australia and/or New Zealand? • Low Dose Unfractionated Heparin (LDUH). • LowMolecular Weight Heparin (LMWH). - enoxaparin. - dalteparin. • Fondaparinux. • Warfarin. • Rivaroxaban. • Dabigatran Etexilate. • Apixaban Virchow’s Triad and Prophylaxis. Vessel Wall Damage: GCS Coagulation Changes: IPC, FIT & Anticoagulants Stasis: IPC, FIT & GCS Virchow’s Triad B. Are there any contraindications for PHARMACOLOGICAL prophylaxis? The Australia & New ZealandWorking Party on the Management and Prevention of Venous Thromboemolism has recommended that anticoagulants are contraindicated in the presence of: • Active bleeding or high risk of bleeding e.g. Haemophillia, thrombocytopenia (platelet count <50 x 109/L). • History of GI bleeding. • Severe hepatic disease (INR > 1.3). • Adverse reaction to heparin. • Patients on current anticoagulation. • Very high risk of falls and palliative management. • Renal impairment (see manufacturer’s product information for LMWH). Please refer to manufacturers instructions for use/data sheets for more information. VTE Prevention. Pharmaceutical.