NURSING CONSIDERATIONS for ANTICOAGULANTS: WARFARIN Surgery of the eye, brain, or spinal cord.Active internal bleeding, recent trauma in the past three months, history of intracranial hemorrhage or ischemic stroke, gastrointestinal ulcers, coagulopathies or bleeding disorders.Teratogenic (fetal hemorrhage, bone deformities, congenital heart defects, brain malformation in the fetus, spontaneous abortion).Warfarin-induced skin necrosis, purple toe syndrome.Gastrointestinal effects (anorexia, vomiting, diarrhea, abdominal cramps).Undue bleeding (antidote: Vitamin K1, called phytonadione).Surgical procedures: cardiopulmonary bypass, ECMO, PCI.Coagulation disorders like antiphospholipid syndrome and DIC.Cardiac valve replacement or coronary angioplasty.Ischemic stroke, transient ischemic attack.Deep vein thrombosis, pulmonary embolism.Causes an initial period of hypercoagulation (due to protein C depletion) followed by anticoagulation.Inhibits maturation of clotting factors II, VII, IX, X and anti-coagulation proteins C, S.Blocks vitamin K epoxide reductase and prevent regeneration of vitamin K epoxide, which is a cofactor for the enzyme gamma-glutamyl carboxylase, which converts the non-functional forms of coagulation factors II, VII, IX, and X and anticoagulation proteins C and S, into their functional forms.
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