Anticoagulation therapy treats, prevents formation of dangerous clots
Parkland pharmacists guide, support at-risk patients
About 20 years ago Debra Rios, of Dallas, had a routine colonoscopy. “After the procedure my doctor asked me, ‘Do you realize how fast your heart rate is?’ I told him I had no idea,” she recalled.
Physicians later determined Rios, 67, needed carotid endarterectomy surgery to open and clean the carotid artery blocked by plaque, with the goal of preventing a stroke. “I had the procedure and I’ve been on anticoagulation medication ever since,” she said.
Rios is one of approximately 1,600 patients receiving anticoagulation management services at Parkland Health & Hospital System. Rios visits the clinic a couple of times a month. While there a prothrombin time test is performed by taking a small blood sample to measure how quickly her blood clots. Depending on results, medication dosages are adjusted to meet the patient’s needs.
“The Parkland Anticoagulation Service’s main mission is to provide education, while safely managing the use of anticoagulation therapy for our patients,” said Beesha Cherucheril, PharmD, senior ambulatory clinical pharmacist at Parkland.
Blood clotting, or coagulation, is an important function in the body. The blood’s ability to clot prevents minor scrapes and cuts from bleeding uncontrollably. Blood clots form when platelets and plasma proteins thicken, forming a semisolid mass. Coagulation prevents excessive bleeding when a blood vessel is injured. Clots become dangerous when they form inside vessels without injury or do not dissolve naturally. In some cases the clots can travel to other parts of the body, causing harm.
“When patients are diagnosed with conditions associated with the development of potentially dangerous blood clots or have an active clot, they may be prescribed a blood thinner, such as Warfarin,” said Cherucheril said.
Possible conditions that may warrant the use of a blood thinner include:
• Blood disorders
• Cardiac valve replacements
• Deep vein thrombosis (DVT)
• Heart rhythm problems (such as atrial fibrillation)
• Heart failure
• Stroke
• Pulmonary embolisms (blood clot in an artery in the lung)
“By carefully monitoring and adjusting medication dosing to meet the specific needs of each patient, we can customize therapy to prevent adverse outcomes, improve patient adherence and enhance the efficacy of their anticoagulation therapy,” Cherucheril said.
When patients visit the clinic, they meet with a pharmacist who provides information and answers questions about the medication prescribed.
“A big part of the initial visit is education. We talk about other medications or substances they may be consuming – anything from over-the-counter medicines to herbal vitamins and even energy drinks. Different types of products interfere with anticoagulation medication and the result of those interactions can change the blood’s ability to clot,” Cherucheril said.
Patients who undergo surgeries or even dental procedures must be aware of possible effects of anticoagulant therapy and their regimen may require modifications.
After a recent series of eye surgeries, Rios had to modify her anticoagulation treatment. “Last summer, I visited the clinic every six weeks; now I come a couple of times a month to try to get me straightened out like I was. We’re getting close,” she said.
Rios said she appreciates Parkland’s commitment to educating and monitoring their patients. “I’m very happy with the care here. It’s a big team effort and I think that is a big asset,” she said.
“Our goal is to prevent adverse outcomes like bleeding events and hospital admissions and to keep our patients safe,” Cherucheril said.
For more information on services at Parkland, please visit www.parklandhospital.com.
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