Current evidence on anticoagulant management and outcomes for postpolypectomy: an integrative literature review to assist advanced practice nurses.
Currently, there is a scarcity of research evaluating the safety of performing endoscopies, with or without biopsies, among anticoagulated patients. The purpose of this study was to perform an integrative literature review of current research from 1999 through 2005 on anticoagulant management options and outcomes for postpolypectomy patients. Imogene King's model of nursing was used as a guide for this study. Ten research studies were identified via computerized search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PubMed databases and were limited to studies published in English and studies of rigorous design reporting evidence of direct management. This method of review was modeled after L. H. , who advised analyzing data in a systematic fashion. Comparison of management and outcomes of postpolypectomy patients was conducted, followed by a discussion of the findings. Findings indicated that an adjustment of warfarin doses for the purpose of endoscopy is not necessary, with the exception of clinically complex cases. Studies found no increase in incidence of thromboembolus events when warfarin was adjusted or held. While one study found a case of hemorrhagic complication due to continuation of warfarin, there was no evidence presented that indicated surgery or mortality as a result of this complication. Implications for advanced nursing practice, patient education, and further research are discussed.
Ryle
Stephanie
S
Carle Foundation Hospital, Urbana, Illinois 61801, USA. stephanie.ryle@carle.com
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003113:Colonoscopy / Q000009:adverse effects / Q000451:nursing; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D006040:Goals; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D016294:Models, Nursing; D009720:Nurse Clinicians; D009722:Nurse Practitioners; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D015399:Nursing Research / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety
D000925:Anticoagulants