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Anticoagulation is used to prevent and treat thrombosis and thromboembolic events. Before therapy is instituted, careful consideration must be given to the risk of thromboembolism and to anticoagulation-induced bleeding complications. Current indications for antithrombotic therapy are discussed in detail with specific diseases; they include atrial fibrillation, mechanical prosthetic heart valves, DVT, pulmonary embolism (PE), stroke prevention, and acute arterial or graft occlusion. Relative contraindications to anticoagulation therapy are listed in Table 5-2.
Assays for AT III levels typically are falsely decreased in the setting of acute thrombosis and while the patient is receiving heparin. Treatment of acute thromboembolism is with heparin, which can usually be administered successfully if the AT III level is greater than 50% of normal. Patients with AT III deficiency and an episode of thrombosis commonly are treated with lifelong oral anticoagulation. Women with AT III deficiency should receive full-dose heparin or low–molecular-weight heparin (LMWH) anticoagulation during pregnancy to prevent the risk of deep venous thrombosis (DVT).
Heparin and related therapy 1. Standard unfractionated heparins act principally by potentiating the action of AT III and by accelerating the inhibition of factor Xa and thrombin. AT III also inhibits platelet function. a. Administration. c. v. ) should be administered before surgery and every 8–12 hours thereafter. v. ). The amount of heparin is typically prepared as 25,000 units/250-mL bag of intravenous fluid to prevent inadvertent massive overdose. PTT should be measured before initiation of heparin and 6 hours after the initial bolus or at each change in dosing.