Management Considerations

Have the antidote for heparin (protamine sulfate) and warfarin (vitamin K) available for emergency use in case of hemorrhage.

Avoid administering aspirin to patients on anticoagulants because the synergistic effect may induce bleeding.

Avoid the following procedures if possible because of the risk of increased bleeding: intramuscular injections, central line insertions, arterial cannulation, lumbar puncture, and surgical procedures.

Note that the following conditions are relative contraindications to anticoagulant therapy: active bleeding, cerebrovascular accident, severe hypertension, pericarditis and endocarditis, pregnancy (particularly warfarin therapy), and chronic alcoholism.

Note that the following medications may interact with warfarin:

• Increased activity: Allopurinal, cimetidine, indomethacin, metronidazole, oral hypo-glycemic agents, phenothiazines, quinidine, tricyclic antidepressants

• Decreased activity: Barbiturates, oral contraceptives, rifampin. Apply pressure on all punctures for 5 minutes or as long as needed to stop bleeding.

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