Anticoagulants
- inhibit the action or formation of clotting factors
- prevent clot formation and stabilize existing clots
- Do not lyse existing clots
Anti platelet drugs
- Inhibit platelet aggregation
- Prevent platelet plugs
Thrombolytic drugs
-Lyse existing clots
what is the MOA/drug effects of Heparin?
Binds to a substance called antithrombin III which turns off 3 main activating factors (II, IX, X).The overall effect is that it turns off the coagulation pathway and prevents clots from forming. It cannot lyse a clot.
Indication/ route
- Parental, short half-life (1-2 hrs) monitored by activated partial thromboplastin times(aPTT).
- Effects reversed by Protamine sulfate
Nursing implications of Heparin
- IV doses may be given by bolus or IV infusions
- Anticoagulant effects seen immediately
- Lab values done daily to monitor coagulation effect (aPTT)
- Monitor for heparin induced thrombocytopenia (HIT)
aPTT normal ranges
- 40 sec
- therapeutic 1.5-2.0 times normal
Low- molecular weight Heparins MOA
- Synthetic with smaller molecular structure. More specific for factor X. Therefore more predictable anticoagulant response.
Nursing implications of Low-molecular weight heparins
- does not require lab monitoring. Given SQ with 5/8 in, 25-28 gauge needle in abd.
Examples of low-molecular weight heparins
- enoxaparin (Lovenox)
- dalteparin (Fragmin)
Nursing implications of low-molecular weight heparin
- given SQ in abd.
- Rotate injection sites
- no lab monitoring required
MOA of warfarin
- Inhibits vitamin K synthesis by bacteria in the GI tract. this turn inhibits production of clotting factors II, VII, IX, X. These factors are normally synthesized in the liver and are known as vitamin K-dependent clotting factors.
- Prevent clot formation.
- Does not lyse clot
Nursing Implications of Warfarin
- Given orally only
- monitored by prothrombin time(PT) and INR.
What is the antidote for warfarin toxicity ?
Vitamin K
Examples of warfarin
warfarin (Coumadin)
Antidote for Heparin
Protamine Sulfate
Lab Values for warfarin
PT- 11-15 sec
INR- normal- 1.0
Therapeutic coumadin level -2.0-3.0
Nursing implications for warfarin
- may be started while pt on heparin until PT-INR levels indicate adequate anticoagulation
- Full therapeutic effect takes place over several days
- Monitor PT-INR regularly
Pt ED
- take exactly as directed
- if a dose is missed take ASAP
- do no double up doses
- review foods high in vit K (will counter act med) dark leafy veggies
- must keep follow up appts
- instruct on brushing teeth with soft brush
- report any unusual bleeding or bruising
Adverse effects of Anticoagulants
- bleeding
- nausea, vomiting, abd cramps, thrombocytopenia
Contraindications of anticoagulatants
- Use with extreme caution
- severe uncontrolled hypertension
- hemorrhagic stroke
- bleeding disorders
- GI bleeding/ ulcers
- recent spinal cord surgery or ophthalmologic surgery
Anticoagulation pt ed
- lab tests regularly
- signs of abd bleeding
- measure to prevent bleeding, bruising, and tissue injury
- wearing a med alert bracelet
- consulting doc before taking other meds or OTC products, including herbals
Antiplatlets MOA
- Suppress platelet aggregation.
- Prevention of MI, acute MI, ischemic strokes, and coronary stenting
Examples of antiplatelet drugs
ASA Clopidogrel (Plavix)
