Inpatient Anticoagulation

Margaret C. Fang, MD, MPH, is an academic hospitalist and assistant professor of medicine at the University of California, San Francisco. Her research interest is in how best to prevent stroke in older patients with atrial fibrillation. In particular, her goals are to explore clinical and biological risk factors for stroke, identify the optimal use of anticoagulants to prevent atrial fibrillation-related stroke, and direct attention toward social and behavioral barriers to optimal anticoagulant management. Eventually, she would like to develop interventions directed at improving clinical decision-making regarding anticoagulation therapy for the oldest patients. Dr. Fang trained in internal medicine at the Beth Israel Deaconess Medical Center in Boston and subsequently completed a research fellowship at Massachusetts General Hospital, obtaining a Masters of Public Health. She joined the staff at UCSF in 2003, where she is a practicing hospitalist as well as a clinician-investigator. She is currently part of the ATRIA Study Group, an NIA-funded study of warfarin use and outcomes in a large cohort of patients with atrial fibrillation.

Preface vii Contributors ix

1. Pharmacology of Parenteral Anticoagulants 1
Kathleen H. McCool and Daniel M. Witt

2. Pharmacology of Vitamin K Antagonists 25
Jaekyu Shin and Steven R. Kayser

3. Antiplatelet Medications 47
Michael Kornfeld and Joseph R. Munsayac

4. Newer Oral Anticoagulants 67
Taki Galanis and Geno J. Merli

5. Prevention of Venous Thromboembolism in Medical Patients 81
Alex C. Spyropoulos and Charles E. Mahan

6. Prevention of Venous Thromboembolism in Surgical Patients 107
Nancy Torres Finnerty and Franklin Michota

7. Treatment of Acute Venous Thromboembolism in Hospitalized Patients 137
Tracy Minichiello, Lauren Doctoroff, and Elizabeth A. Farrell

8. Perioperative Management of Oral Anticoagulants and Antiplatelet Agents 161
Ramiro Jervis and Andrew Dunn

9. Prevention of Cardioembolic Stroke 179
Ali Mahajerin and Warren J. Manning

10. Antithrombotics for Ischemic Stroke 205
Fadi B. Nahab and Sakib Qureshi

11. Antithrombotic Therapy for Non-ST-Elevation Acute Coronary Syndrome 223
David Lao and Andrew Boyle

12. Parenteral Anticoagulants: Special Considerations in Patients with Chronic Kidney Disease and Obesity 241
Sarah A. Spinler, Millie Rajyaguru, Julie K. Atay, and John Fanikos

13. Hemorrhagic Complications of Anticoagulants in Hospitalized Patients 291
Allison Burnett, Jason Cohen, and David A. Garcia

14. Heparin-Induced Thrombocytopenia 331
David Feinbloom and John Fani Srour

15. Transitions in Care: Inpatient Anticoagulation 361
Neil Gupta, Diane Sliwka, and Margaret C. Fang

16. Optimizing Inpatient Anticoagulation: Strategies for Quality Improvement 377
Greg Maynard, Ian Jenkins, Brian Clay, Michael Montazeri, and Doug Humber

Index 415