الفهرس 
Physiology of coagulation systemOnly 14 pages are availabe for public view
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Abstract
Most patients admitted to ICU have multiple risk factors for thromboembolic complications which are present in the form of DVT and pulmonary embolism. In such settings, there are strong indications for prolonged thromboprophylaxis and tretment of thrombotic complications.
The parentral anticoagulants heparin, LMWH, fondaparinux, Hiurudin, argatroban have been used effectively to prevent clots in ICU. This parentral anticoagulants play an important role in theraputics when rapid onset and offset of anticoagulation is needed, On the other hand the oral anticoagulants are mainly used for long term anticoagulation.
Oral anticoagulation with vitamin k antagonist, warfarin, Use increase world wide due to its effecacy in preventing stroke in patients with AF and treating patients with recurrent thrombembolic disease. Despite warfarin, s effecacy its management remains problematic due to its complex pharmacokinetics, and pharmacodynamic properties.Warfarin also has narrow theraputic range, frequent drugsand food interactions also warfarin requires vigilant coagulation monitouring, clinical surveillance and continous patient education.
New oral anticoagulants are increasingly replacing the older parentral agents and vitamin K antagonists in clinical practice. These agents include the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxiban and apixaban. Advantages of this new agents include there relatively rapid onset and offset of action and predictable anticoagulant effect so that routine coagulation monitoring is not required.
It is important to consider the patient treated with these agents will be exposed to different clinical situations (spontinous or postoperative bleeding, overdose, trauma, and elective or emergent surgical procedures) that require different intervention.