Anticoagulants and thrombolytics. Risks and Benefits

The increased use of anticoagulation agents in critical care is associated with both hemorrhagic and thromboembolic sequelae. Bleeding is associated with thrombolytic agents, heparin, and warfarin; serious hemorrhage may require the administration of antifibrinolytic drugs, protamine sulfate, or vitamin K₁, respectively. Recognition of early signs and symptoms of bleeding such as pain, neurologic symptoms, and metabolic abnormalities enable one to make an early diagnosis and institute treatment promptly. Heparin administration is associated with a delayed-onset thrombocytopenia with thrombosis and may lead to amputation. Warfarin depletes proteins C and S causing thromboembolic episodes, including a rare skin necrosis, which may be prevented by administering both heparin and warfarin for 4 to 5 days.