Hematology pharmacology: anticoagulant, antiplatelet, and procoagulant agents in practice

Alterations in hemostasis and coagulation are common problems during critical illness. For that reason, it is essential that advanced practice and critical care nurses have an understanding of the medications used to treat these potentially deadly disorders. The antithrombotic drugs, including anticoagulants, antiplatelet agents, and fibrinolytics, are among the most frequently used drug therapies in the United States. These agents prevent and treat the thrombotic diseases, a leading cause of morbidity and mortality. Anticoagulants, the indirect and direct thrombin inhibitors as well as the vitamin K antagonists, are critical in treating venous thrombosis and preventing serious thrombotic complications with atrial fibrillation. The antiplatelet drugs work to decrease platelet aggregation and are especially effective in preventing and managing arterial thrombus. On the other end of the spectrum, the procoagulants are used to help prevent and control blood loss. These agents include human blood stimulators, human factor concentrates, including recombinant activated factor VIIa, and desmopressin.