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Antiplatelet and anticoagulant side effects: An EMS review

EMS providers treating head injuries and GI bleeds should check medication history for antiplatelets and anticoagulants to prevent hemorrhage

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The EMS1 Academy features “Module 11: Principles of Pharmacology,” a 30-minute accredited course for EMTs. This defines the terms pharmacodynamics, therapeutic effects, indications, side effects, unintended effects, and untoward effects. Visit the EMS1 Academy to learn more and schedule a demo.

We’ve addressed the 10 most commonly encountered medications seen in EMS on a prior podcast. In this episode, the MCHD Paramedic Podcast crew focuses on a less common but often more impactful group of medications, antiplatelets and anticoagulants. The combination of complex pharmacology and some relatively new drugs in both classes, makes this an area prime for discussion and review.

Patients taking antiplatelets or anticoagulants have high-risk disease processes which result in them being prescribed in the first place, and the bleeding side effects from taking these drug classes can be catastrophic.

Antiplatelet medications are most commonly used for coronary artery disease, stroke and other peripheral vascular disease. Anticoagulants are used primarily to treat pulmonary emboli, deep venous thrombosis and in patients with mechanical heart valves.

Both classes increase the patient’s risk of spontaneous and traumatic hemorrhage. The most common locations for this bleeding is in the gastrointestinal tract and intracranially. It is vital that EMS providers scan the medication list when caring for potential GI bleeds and closed head injuries as the presence of any of the medications discussed will drastically alter the risk profile. This will likely be treatment altering information when passed on the emergency department providers as well.

After listening to the episode, your skills as a medication list detective will be refreshed and sharp. The next time you encounter a patient on a newer direct oral anticoagulant, not only will you recognize the medication, you’ll have the background pharmacologic knowledge to understand modes of action and indications for use as well.

Antiplatelet and anticoagulant medications

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.