Anticoagulation Stewardship at Huntsville Hospital
The Anticoagulation Stewardship program anchors anticoagulant dosing, safety, and reversal practice at Huntsville Hospital. It supports pharmacists, providers, and perioperative teams across the system.
Documents on this page are approved through the Pharmacy and Therapeutics Committee. Each entry carries its scope, its approval date, and a link to the current version.
Target INR ranges and treatment durations by indication, reconciled to the 2020 ACC/AHA and 2025 ESC/EACTS valvular heart disease guidelines, the 2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline, and current CHEST VTE guidance.
Reference recommendations for management prior to surgery and invasive procedures: preoperative hold intervals for anticoagulants, antiplatelets, and NSAIDs by bleeding-risk tier, resumption after the procedure, and neuraxial anesthesia intervals.
Clinical decision pathway for factor Xa inhibitors, warfarin, and dabigatran: time since the last dose, criteria to administer KCentra, vitamin K, or Praxbind, the infusion rate worksheet, and repeat-dose evaluation.
Pharmacist-managed enoxaparin dose adjustment and anti-Xa monitoring: maximum dosing in morbid obesity, automatic prophylactic adjustments, therapeutic and prophylactic nomograms, pregnancy considerations, and criteria for monitoring.
Preferred and alternative stocked blood factor products by coagulopathy and inhibitor status. Confirm current stock and dosing with Pharmacy, and involve Hematology for patients with inhibitors.
Daily clinical coverage, safety surveillance, reversal and blood factor management, formulary work, and teaching, for Huntsville Hospital and the system hospitals.
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