New anticoagulant medications have expanded options to prevent venous thromboembolism (VTE) and treat patients at risk for excessive blood clots.

These newer therapies and advances in care make it especially important for nurses and other advanced practice providers to stay current on the latest research and evidence-based practice related to patients with hematologic and oncologic disorders, as these specialties continually evolve.

“Anticoagulant Medications for the Prevention and Treatment of Thromboembolism” outlines the traditional anticoagulant therapies familiar to most critical care providers as well as newer medications introduced in recent years. The article is published in AACN Advanced Critical Care.

Author Lori Brien, MS, ACNP-BC, is an acute care nurse practitioner in cardiovascular and thoracic surgery at Virginia Hospital Center, Arlington. She also serves as assistant program director of the Adult Gerontology-Acute Care Nurse Practitioner program, School of Nursing and Health Studies at Georgetown University, Washington, DC.

“Although certain therapies such as heparin and warfarin are time-tested and generally well understood by providers, use of novel anticoagulants provides both patients and providers with attractive options,” she said. “Clinicians should be aware of the available medications and their unique characteristics. It is important to choose the most appropriate agent on the basis of the clinical situation, patient characteristics, and drug properties.”

For decades, warfarin was the only oral anticoagulant available, and its advantages and disadvantages are well documented. During the last 10 years, new medications, including direct thrombin inhibitors and factor Xa inhibitors, have become available for the prevention and treatment of VTE.

With some limited exceptions, randomized, controlled trials establish that these newer oral anticoagulants provide at least equal, if not superior, systemic anticoagulation compared with warfarin. Furthermore, the predictable pharmacodynamics of these anticoagulants provide reliable anticoagulation with a lower bleeding risk and eliminate the need for routine monitoring, both of which directly benefit patients.

The article is part of a symposium published in the summer 2019 issue of the peer-reviewed journal that focuses on hematology-related aspects of patient care and implications for future practice.

Thomas VanDruff, MS, ACNP-BC, served as editor for the symposium. He is an acute care nurse practitioner in medical/surgical critical care for PMA Health at the Virginia Hospital Center.

“The specialty of hematology continues to advance and grow, with new treatment regimens, novel medications, and the ever-changing landscape of hematologic and oncologic practices,” he said. “Although seemingly disparate subjects, hematopoiesis, coagulation, oncology, and immunology are interwoven and interdependent.”

AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles, and columns of interest to critical and progressive care clinicians. The American Association of Critical-Care Nurses (AACN) publishes the journal.

Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.